CD4 ⁺ FOXP3 ⁺ regulatory T cells (T _regs ) suppress immune responses to tumors, and their accumulation in the tumor microenvironment (TME) correlates with poor clinical outcome in several cancers, including breast cancer (BC). However, the properties of intratumoral T _regs remain largely unknown. Here, we found that a functionally distinct subpopulation of T _regs , expressing the FOXP3 Exon2 splicing variants, is prominent in patients with hormone receptor–positive BC with poor prognosis. Notably, a comprehensive examination of the TCGA validated FOXP3E2 as an independent prognostic marker in all other BC subtypes. We found that FOXP3E2 expression underlies BCs with defective mismatch repair and a stem-like signature and highlights pathways involved in tumor survival. Last, we found that the TME induces FOXP3E2 through the CXCL12/CXCR4 axis and confirmed the higher immunosuppressive capacity of FOXP3E2 ⁺ T _regs derived from patients with BC. Our study suggests that FOXP3E2 ⁺ T _regs might be used as an independent biomarker to predict BC prognosis and survival and to develop super-targeted immunotherapies.

Background: Breast cancer remains the most prevalent malignancy among women worldwide, necessitating effective prevention strategies. The current literature was scrutinized to investigate the impact of dietary factors, such as the consumption of fruits, vegetables, and whole grains, and dietary patterns such as the Mediterranean diet on reducing the risk of breast cancer. Additionally, the potential role of diet in diminishing the risk of disease recurrence and enhancing outcomes among breast cancer survivors was explored. Methods: A systematic literature search was conducted using PubMed, Web of Science, Scopus, and EMBASE to identify relevant studies published between 2000 and 2024. Inclusion criteria were applied to select studies with robust methodologies, including randomized clinical trials, meta-analyses, and prospective cohort studies focusing on adult women. Only studies published in English were considered. Papers on animal studies, editorials, and case series were excluded. Results: Our findings show the critical interplay between diet and breast cancer prevention, crucial for the development of effective strategies to both primary and tertiary prevention. Challenges such as adherence to dietary recommendations, cultural and socioeconomic disparities, and limited high-quality evidence were identified. Conclusions: This review underscores the critical need to integrate nutrition into clinical practice and highlights avenues for future research, including personalized dietary interventions.

Background: The pursuit of optimal aesthetic outcomes in breast surgery has led to the evolution of various surgical techniques. The transaxillary approach leads to high patient satisfaction due to its aesthetic advantage of avoiding visible scars on the breast. This approach is particularly useful in procedures such as breast augmentation and reconstructive surgery after breast cancer treatment, in which achieving an optimal cosmetic outcome is key. In this study, the authors compared the transaxillary blind approach with their new semiendoscopic video-assisted transaxillary approach, and analyzed the benefits and limitations of each method. Methods: A total of 118 patients were randomized to either the transaxillary blind approach or the semiendoscopic video-assisted transaxillary approach for breast augmentation from April of 2019 through December of 2022. Results: The results indicate that the semiendoscopic video-assisted approach required longer operative times but was associated with a lower incidence of complications, including asymmetry (eg, bottoming out, double-bubble deformity), breast animation deformity, and capsular contracture. Conclusions: This randomized trial revealed advantages and limitations of the transaxillary blind approach and a new semiendoscopic video-assisted transaxillary approach, highlighting that endoscopic assistance significantly improved surgical outcomes while maintaining an acceptable surgical time.

Pre-operative breast imaging is a critical component of the decision-making process for both oncological and reconstructive surgeons. The thickness of the non-glandular breast tissue coverage (BTC), including the skin and the subcutaneous fat layer overlying the anterior lamella of the capsula mammae, varies according to the single patient's breast anatomy. This layer correlates with an anatomical and properly performed mastectomy to optimize mastectomy flap thickness. The aim of this study is to validate a BTC assessment modality that uses digital mammography (DM) imaging in both the cranio-caudal (CC) and the medio-lateral oblique (MLO) views. We designed a retrospective, multi-reader study on a dataset of 40 unilateral DM cases obtained in the two standard views (CC and MLO). The study set was extracted from all consecutive cases recorded from January 2022 to March 2022 in two Breast Imaging Academic Centers involved in the project (the Breast Unit of the University of Naples Federico II and the Breast Unit of the University of Turin). The robustness of the proposed pre-operative assessments has been determined by deriving the metrics associated with the inter- and intra-observer agreement (P values of the matched measurements, measurement error, repeatability, limits of agreement, correlation) for each testing site and for their possible aggregations. We found a highly satisfactory inter-observer agreement with good correlation among the four senior radiologists' measurements in all positions and on breasts of different density. The intra-observer agreement was also good: no significant differences and good correlation for either one. The method performed well also when used by less expert radiologists, satisfying the requirements for accuracy and repeatability set by the senior team. The analysis of the measured thickness consistently indicated a larger measurement error for the non-dense breast data than for the dense ones. The proposed approach seems to be well-standardized and reproducible, allowing good performance at different levels of experience. It is our hope that this methodological study will assist with preoperative surgical planning by providing a clinical validation tool to estimate mastectomy flap thickness and its impact on preoperative decision-making for optimizing surgical-reconstructive outcomes, both from the oncological and the aesthetic point of view.