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Objectives. The retinoblastoma (RB) pathway is crucial in the development and progression of many cancers. To better understand the biology of progressive breast cancer (BC), we examined protein expression of the RB pathway in primary BCs and matched axillary lymph node metastases (LM). Methods. Immunohistochemistry was used to evaluate cyclin D1, CDK4/6, RB, phosphorylated RB (pRB), and E2F1 expression in tissue arrays containing cores of 50 primary BCs and matched LM. The number of positive tumor cells and staining intensity were scored. Results. The proteins were localized in the nucleus, while CDK6 was detected in the cytoplasm and CDK4 was found in both. pRB and E2F1 showed higher expression in matched LM than in primary tumors. Expression of these proteins differed significantly by the percentage of positive tumor cells, while proteins in the proximal portion of the RB pathway showed no significant differences. The main path of alteration consisted of high pRB in primary BC, remaining pRB high in the majority of LM, variations occurring in fewer cases. All matched LM of the few primary tumors that had unaltered RB and pRB expression showed changes in RB or pRB expression. Conclusion. Expression of pRB and E2F1 was significantly higher in LM than in primary BC. A majority of cancers with LM showed altered RB or pRB expression, suggesting that proteins downstream in the RB pathway play a critical role in metastatic BC and disease progression. So looking at the RB pathway could be an option for chemotherapy decisions in patients with only few LM. [ABSTRACT FROM AUTHOR]

Germline variations in the BRCA‐1 and BRCA‐2 genes are associated with an increased risk of breast cancer. These variants are found in 5% of all breast cancer cases. Prophylactic mastectomy is the most effective risk‐reducing method and shows high rates of patient satisfaction and acceptance. We established a registry of Austrian BRCA‐1 and BRCA‐2 mutation carriers who had undergone mastectomy for oncologic or prophylactic reasons. Data were collected on the type of operation, complications, and type of reconstructive surgery for patients between 2014 and 2017. The complication rate in patients with nipple‐sparing mastectomy was significantly lower (23.1%) than in those with other types of mastectomies (60.7%; P =.005). In patients with implant‐based breast reconstruction, subpectoral placement was associated with a significantly higher rate of complications than prepectoral placement (P =.025). Median implant volume was 350 cc (range: 155‐650 cc), and a 100‐cc increase was associated with doubling of the odds of a complication (regression coefficient = 0.007); based on this finding, some surgeons may decide on using smaller implants. In summary, we identified significant associations between the risk of complications and surgical characteristics, and found host factors like diabetes, BMI, and smoking among Austrian patients with BRCA‐1 and BRCA‐2 variants. [ABSTRACT FROM AUTHOR]

Background: Since skin‐ and nipple‐sparing mastectomies (SSM/NSM) are now considered oncologically safe options, the number of immediate implant‐based breast reconstructions (IBBR) has increased. We present our experience with different techniques of immediate and delayed IBBR over a period of 5 years. Methods: A single center, retrospective, cohort study was performed from January 2008 to January 2013. Complications, reconstructive failure, contralateral adjustment, cosmetic outcome, patient's quality of life, and the thickness of the overlying tissue were compared between different techniques of immediate and delayed IBBR. Results: A total of 180 patients who underwent immediate (n = 148, 82.2%) or delayed (n = 32, 17.8%) IBBR after SSM (n = 62, 34.4%), NSM (n = 21, 11.7%), or total mastectomy (n = 97, 53.9%) were included. The mean follow‐up was 46 months. Immediate IBBR was associated with better cosmetic outcomes (P = 0.026), fewer surgical interventions (P = 0.017), and better quality of life (P = 0.004). Patients with NSM showed the best quality of life results (P =< 0.001) and the best cosmetic outcome (P = 0.001). While immediate IBBR with direct‐to‐implant procedures achieved a trend toward best cosmetic outcomes (P = 0.66), it was associated with the highest complication rate (37.1%) compared to permanent expanders (10.5%) and a two‐stage expander‐to‐implant procedure (22.9%; P = 0.013) without a significant difference in the rate of implant loss (P = 0.51). Conclusion: Whenever oncologically feasible, immediate IBBR should be offered to the patient. The advantages of immediate IBBR with a direct‐to‐implant procedure such as better cosmetic outcome and fewer surgical interventions should be weighed up against the relatively high overall complication rate associated with this procedure. [ABSTRACT FROM AUTHOR]