Editor’s Note: Breast reconstruction surgery offers hope for patients to regain confidence and beauty in the field of breast cancer treatment. With advances in medical technology, implant-based breast reconstruction has become a mainstream choice. However, complications related to implants remain a key concern for both surgeons and patients. At the 16th Shanghai Breast Reconstruction Conference, Dr. Benlong Yang from the Breast Surgery Department of Fudan University Shanghai Cancer Center led a session discussing "Implant Complications." Following the event, Oncology Frontier interviewed Dr. Yang to delve into key issues surrounding implant reconstruction.

Q1. Oncology Frontier: As the moderator of “Session 2: Practice and Controversies” at the 16th Shanghai Breast Reconstruction Conference, can you share the clinical significance and importance of the topic “Implant Complications” for breast cancer patients?

Dr. Benlong Yang: Implant-based breast reconstruction is currently the mainstream approach, chosen by around 70% of patients. Nationwide, we conducted a survey among breast reconstruction surgeons to understand their major concerns when opting for implant-based reconstruction. Two main issues stood out: first, cost control of implant materials, and second, safety concerns (particularly complications).

Currently, the cost of implant materials ranges between 20,000 and 30,000 RMB, and any failure or complication during surgery can lead to immense pain for the patient, as well as financial losses. Therefore, most surgeons prioritize the success rate of each surgery and the prevention (or minimization) of complications over achieving a perfect cosmetic outcome. During the “Implant Complications” session, we had an in-depth discussion on why and when complications occur, how to prevent them, and the treatment pathways when they arise. A key reason why many hospitals perform fewer implant reconstructions is that if complications occur, the doctors are unsure of how to handle them. Hopefully, this session’s detailed discussion and treatment pathways will provide the necessary guidance for surgeons to effectively respond to such situations.

Q2. Oncology Frontier: In the discussion on “Implant Complications,” Dr. Jian Liu presented a pathway for managing long-term complications of pre-pectoral breast reconstruction. Could you elaborate on the key steps and challenges of this pathway?

Dr. Benlong Yang: During the implant-based reconstruction process, the layer and positioning of the implant are always key points of discussion. Initially, implants were placed in front of the pectoral muscle, but later, it was found that reconstruction behind the pectoral muscle provided better outcomes and safety. As a result, implants were shifted to a submuscular position. However, submuscular reconstruction also had drawbacks, such as disrupting the patient’s normal pectoral muscle tissue and causing motion deformities. To meet patient needs, and when combined with conservative mastectomy techniques, there is now a trend of repositioning the implant in front of the pectoral muscle to improve the patient’s quality of life.

Pre-pectoral breast reconstruction is still an emerging surgical method, and data on its long-term complications are limited. Dr. Jian Liu, one of the pioneers in pre-pectoral breast reconstruction in China, was specially invited to share his expertise on this topic. He provided valuable insights on key issues such as managing and preventing complications.

Q3. Oncology Frontier: Dr. Zhenggui Du’s presentation on managing flap necrosis and infections in endoscopic implant reconstruction attracted widespread attention. What is your assessment of this pathway? From your clinical experience, how can we effectively prevent such complications?

Dr. Benlong Yang: In recent years, there has been a rise in the popularity of “endoscopic” and “robotic” surgeries in breast surgery in China. Many specialists are choosing to perform mastectomies and implant placements using endoscopes or robotic assistance. The advantages of these techniques are clear: they preserve the integrity of the breast skin and leave no visible scars on the breast surface. However, due to the limited experience we have accumulated so far, if complications arise (such as flap necrosis or infections), incisions still need to be made on the breast surface, thus not avoiding scars altogether. Therefore, we invited Dr. Zhenggui Du, who has extensive experience in endoscopic breast reconstruction, to share his approach to managing complications in endoscopic reconstruction.

In my own clinical practice, I also use endoscopic techniques when placing implants, as it not only enhances the breast’s aesthetic appearance but also reduces the risk of implant exposure. To minimize the occurrence of complications like flap necrosis and infections, I opt for cold knife dissection to reduce heat damage to the flaps, and I ensure sterile procedures to increase the safety of the reconstruction by limiting contact with the implants.

Q4. Oncology Frontier: Based on the discussions at this conference, what research topics do you believe warrant further exploration in the field of implant complications? What specific suggestions or expectations do you have for improving the safety and success rates of implant-based surgeries?

Dr. Benlong Yang: Implant-based reconstruction is a highly personalized surgical process, and the specific implementation of each patient’s surgical plan varies. The complications and risks faced by different patients are also not the same. In the face of diverse complications and recurrence risks, we need to establish systematic and standardized treatment protocols. In response to these issues, we plan to introduce guidelines or consensus recommendations on handling complications in the future.

Complication prevention remains the primary focus in breast reconstruction, with the goal being to avoid complications altogether. We will continue to refine expert guidelines to outline situations that should be avoided and emphasize strict adherence to safety protocols. I believe these guidelines and consensus recommendations will help us further ensure the safety of breast reconstruction procedures.

Dr. Benlong Yang

Deputy Chief Physician, Department of Breast Surgery, Fudan University Shanghai Cancer Center PhD in Oncology, mentored by Professor Jiong Wu Executive Committee Member, Chinese Anti-Cancer Association Breast Cancer Integrated Prevention and Screening Committee Committee Member and Secretary, Breast Cancer Committee of the Chinese Anti-Cancer Association Secretary, Integrated Breast Cancer Committee of the Chinese Anti-Cancer Association Expert Committee Member, Breast Surgery Working Group of the Chinese Medical Doctor Association Surgical Physicians Branch Committee Member, Breast Cancer Committee of the Chinese Health Promotion Foundation Deputy Leader, Youth Expert Group of the Breast Cancer Committee of the Chinese Anti-Cancer Association Vice-Chairman, Breast Committee of the Zhongguancun Minimally Invasive Alliance Board Member, Fudan University Medical Science Popularization Youth Alliance Secretary of the CBCS Guidelines Compilation Group and Member of the Lecture Tour Group Founder of the video series “Not Your Average Doc”