Angiotensin II (Ang II) AT₁ receptors are involved in the regulation of the stress response. In adult male rats, acute restraint increased AT_1A mRNA in paraventricular nucleus. Repeated restraint increased AT_1A mRNA and AT₁ binding in paraventricular nucleus and AT₁ binding in subfornical organ and median eminence. AT_1B and AT₂ receptors were not expressed in brain areas involved in the stress response. Acute restraint increased anterior pituitary AT_1A mRNA and AT₁ binding and decreased AT_1B mRNA. During repeated restraint, the increase in AT_1A mRNA in the anterior pituitary was maintained, but AT_1B mRNA and AT₁ binding returned to normal levels. In adrenal zona glomerulosa, AT_1B mRNA, AT₁ binding, AT₂ mRNA and AT₂ binding decreased during acute restraint. Receptor mRNA and binding returned to normal after repeated stress, with the exception of rebound increase in adrenal zona glomerulosa AT₂ mRNA. In adrenal medulla, AT_1A mRNA increased and AT₂ mRNA decreased during acute restraint. AT_1A mRNA remained increased during repeated restraint, while alterations in AT₂ mRNA were no longer present. Expression of AT_1A, AT_1B and AT₂ receptors in the hypothalamic-pituitary-adrenal axis is tissue specific and is different in acute and repeated stress. Increased brain, pituitary and adrenomedullary AT_1A receptor expression correlates with hypothalamic-pituitary-adrenal axis stimulation, supporting the hypothesis of Ang II, through selective AT_1A receptor stimulation, as an important determinant of the acute and repeated stress response. Decreased adrenal zona glomerulosa and anterior pituitary AT_1B receptors during acute stress can be interpreted as compensatory to increased stimulation by Ang II. There may be additional roles for adrenal AT₂ receptors during acute stress, possibly related to interaction or cross-talk with AT₁ receptors.

The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated. The surgical treatment of these patients is controversial, with several questions remaining unanswered. Is breast conservation therapy feasible in this patient population and can these patients retain their implants? A retrospective review of all breast cancer patients with a history of previous augmentation mammaplasty who were treated at the Revlon/UCLA Breast Center between 1991 and 2001 was performed. During the study period, 58 patients were treated. Thirty patients (52 percent) were treated with a modified radical mastectomy with implant removal. Twenty-eight patients (48 percent) underwent breast conservation therapy, which consisted of lumpectomy, axillary lymph node dissection, and radiotherapy. Twenty-two of the patients who underwent breast conservation therapy initially retained their implants. Eleven of those 22 patients (50 percent) ultimately required completion mastectomies with implant removal because of implant complications (two patients), local recurrences (five patients), or the inability to obtain negative margins (four patients). Nine additional patients experienced complications resulting from their implants, including contracture, erosion, pain, and rupture. The data illustrate that breast conservation therapy with maintenance of the implant is not ideal for the majority of augmented patients. Breast conservation therapy with explantation and mastopexy might be appropriate for rare patients with large volumes of native breast tissue. Mastectomy with immediate reconstruction might be a more suitable choice for these patients.