Debate article: Management of breast cancer in patients with pre-existing bilateral breast augmentation-a snapshot of global practice and call for international guidelines.

Breast cancer (BC) is the most common female cancer, and as bilateral breast augmentation (BBA) increases, more women are presenting with BC within an augmented breast. No international guidelines exist on how to manage such a situation, so this group undertook a global survey to provide a snapshot of current surgical practice. The key finding was the variable oncoplastic management of BC after BBA: most surgeons responded that when oncologically safe, breast conservation with implant preservation was appropriate as radiotherapy was not a contra-indication to preserving implants. Immediate symmetrisation could be considered but was not always available. We propose a large multicenter observational study to support the development of international guidelines. This will help patients, healthcare funders, providers, and surgeons to optimize care and reduce inequity of access to appropriate oncoplastic surgery options for the increasing number of women with BBA and BC.

Pollinator cognition and the function of complex rewards.

The cognitive ecology of pollination is most often studied using simple rewards, yet flowers often contain multiple types of chemically complex rewards, each varying along multiple dimensions of quality. In this review we highlight ways in which reward complexity can impact pollinator cognition, demonstrating the need to consider ecologically realistic rewards to fully understand plant-pollinator interactions. We show that pollinators' reward preferences can be modulated by reward chemistry and the collection of multiple reward types. We also discuss how reward complexity can mediate pollinator learning through a variety of mechanisms, both with and without reward preference being altered. Finally, we show how an understanding of decision-making strategies is necessary to predict how pollinators' evaluation of reward options depends on the other options available.

Omission of breast surgery in selected breast cancer patients with excellent response to neoadjuvant systemic therapy.

Modern neoadjuvant systemic therapy (NST) can result in high pathologic complete response rates (pCR) in triple negative (TN) and human epidermal growth factor receptor 2 positive (HER2+) breast cancer. The role of surgery is, therefore, being reconsidered in this rapidly evolving field. This report presents oncological outcomes of seven patients with TN or HER2+ breast cancer, with exceptional response to NST, and a post-NST image-guided vacuum assisted biopsy showing no residual disease (ypT0), who opted not to have breast surgery. The median age was 49 (IQR 36-61) years and the median tumour size at diagnosis was 50 (IQR 16-65) mm. All patients received breast radiotherapy and continued adjuvant systemic therapies as appropriate. At a median follow-up of 67 (IQR 61-77) months, all patients were alive and free of disease. This small case series supports the need for further research in 'exceptional responders' to provide safe, individualized patient-centred care.