Editor’s Note: The 15th Sino-French Breast Reconstruction Congress and the 13th Sino-French Breast Cancer Academic Conference recently concluded successfully in Chongqing, China. During the meeting, Professor Shengchun Liu from the First Affiliated Hospital of Chongqing Medical University sat down with Oncology Frontier to share the “CQMU experience” accumulated over more than two decades. In the interview, Professor Liu discussed the evolution of breast reconstruction strategies from an early predominance of autologous flap reconstruction to the current implant-oriented approach, and explained how breast surgeons should continue to uphold the principle of “achieving optimal outcomes with the least possible surgical trauma” amid the growing trends of minimally invasive surgery and artificial intelligence.01
Oncology Frontier: As Chinese patients place increasing emphasis on breast appearance and quality of life, how do you identify the optimal “balance point” between implant-based reconstruction and autologous tissue volume displacement based on individual anatomical characteristics during clinical decision-making?
Professor Shengchun Liu: As clinicians, our goal should never be reconstruction simply for the sake of performing reconstruction. The first consideration must always be whether the patient is truly an appropriate candidate for reconstructive surgery.
For example, if evaluation suggests that a patient’s anticipated survival is limited, then reconstruction may lose much of its intended value. The foremost prerequisite is oncologic safety. Only after ensuring oncologic safety, confirming that the patient is expected to have a meaningful long-term survival, and determining that reconstruction is genuinely appropriate do we proceed to consider reconstructive options.
When selecting a specific reconstructive approach—whether autologous tissue reconstruction or implant-based reconstruction—we must comprehensively evaluate multiple factors, including the patient’s body habitus, breast morphology, and overall anatomical characteristics, in order to determine which method is most suitable.
Throughout this process, our fundamental principle is to achieve the best possible outcome with the least possible surgical trauma. In other words, when conditions permit, we generally prioritize implant-based reconstruction. Compared with implant reconstruction, autologous flap procedures involve greater surgical trauma, longer recovery periods, higher technical complexity, and a more significant physical burden for patients.
Therefore, the philosophy we usually communicate to patients is straightforward: whenever feasible, implant-based reconstruction should be considered first. Only when implants cannot achieve the desired outcome, when the patient’s body characteristics are unsuitable for implants, or when there are other clear indications necessitating autologous tissue reconstruction, do we proceed with flap-based approaches.
Ultimately, the core principle remains unchanged: to pursue the optimal reconstructive outcome with the minimum necessary degree of surgical trauma.
02
Oncology Frontier: Compared with volume replacement techniques, volume displacement procedures are less invasive but place much greater demands on the surgeon’s glandular reshaping skills. Given that Chinese women generally have smaller breast volume and denser breast tissue compared with Western populations, what “CQMU experience” can you share regarding patient selection and technical refinement?
Professor Shengchun Liu: Our institution, the First Affiliated Hospital of Chongqing Medical University, began performing breast reconstruction procedures as early as 2000.
During the initial stages, we observed that Chinese patients differed from Western patients in their acceptance of reconstructive surgery. Through academic exchanges with international experts and review of the literature, we learned that in Western countries, approximately 70% of reconstructions were implant-based, while the remaining 30% involved autologous flaps or hybrid approaches combining implants with autologous tissue.
In China, however, cultural perceptions within Eastern societies initially led many patients to feel hesitant about implant placement. As a result, during our early years, the majority of reconstructions we performed were autologous tissue flap procedures. At that time, approximately 70% of our cases involved autologous reconstruction, whereas only about 30% of patients were willing to undergo implant-based reconstruction.
Over time, as our techniques continued to evolve and patients gradually became more accepting of implants, this distribution changed substantially. We have consistently adhered to the philosophy of achieving the best outcomes through the simplest and least invasive methods whenever possible.
Today, the situation has shifted dramatically. Approximately 70% of our reconstruction patients now undergo implant-based procedures, while the proportion requiring autologous flap reconstruction—due to anatomical limitations or other clinical considerations—has decreased to roughly 30%.
From our experience, the overarching principle remains the same: to achieve the best reconstructive outcome while minimizing surgical trauma as much as possible.
03
Oncology Frontier: As breast surgery increasingly moves toward minimally invasive and robotic-assisted approaches, beyond mastering conventional open surgical techniques, what additional technical skills or cognitive frameworks do you believe surgeons should focus on developing?
Professor Shengchun Liu: At present, the broader trend is clearly moving toward the “surgicalization” of medical therapies and the minimally invasive evolution of surgery itself. The overarching principle across breast disease treatment—and indeed across medicine as a whole—is to achieve the best therapeutic outcomes with the least possible degree of trauma.
With the rapid advancement of artificial intelligence, robotic technology has now genuinely entered our clinical and professional landscape.
From my perspective, artificial intelligence can undoubtedly assist us with certain aspects of medical practice, particularly highly repetitive and mechanically standardized tasks where AI systems possess clear advantages.
However, clinical medicine also involves countless subtle and individualized factors arising from differences between patients. Every patient has unique pathophysiological characteristics and personal needs, and treatment strategies can never follow a completely uniform template.
This is precisely where physicians’ expertise becomes indispensable. Only through clinical wisdom developed over decades of practical experience can doctors formulate truly individualized and precise treatment strategies tailored to each patient.
Therefore, I believe the future lies in effectively integrating the strengths of artificial intelligence with the professional judgment and accumulated experience of physicians. These two elements should complement one another in order to ultimately deliver the best possible outcomes for patients.
Professor Shengchun Liu
