My presentation will be about breast reconstruction in young women, the timing and the different techniques and also the consequences, that is the outcome of breast reconstructions. I look a little bit into what we have been doing in the Karolinska Institute as studies and also the more international studies as well.

The timing is pretty easy because you can do it in two different times, you can do an immediate breast reconstruction, and that is being more and more popular because there are several studies showing that that is good for the patient, or you can do a delayed secondary breast reconstruction which can be done later, after one year but also after many years.

Has bilateral mastectomy changed attitudes towards breast surgery?

It has actually and it has become, as you say, more increasingly popular for several reasons. But we try, at the Karolinska Institute, to limit it to patients that really have an elevated risk for contralateral cancer or having a BRCA mutation. There are a lot of different techniques, of course, where the easiest one is just to put an implant, a permanent implant is the most easy technique, of course, and then you can have different kinds of expansion techniques. Then you have all the flaps and also flaps combined with the implants. In young women, as we will concentrate a little bit on that today, you always have to bear two things in mind when you discuss different techniques. One is that hopefully this woman has a long life expectancy so it has to be durable but also that you will have a possibility to do another reconstruction later if she gets a contralateral cancer, if she has unilateral reconstruction, and also maybe future pregnancies which also in, for instance, mutation carriers might be coming in the future for these patients.

What are the outcomes?

The most important outcome, of course, when you do breast reconstruction, and I'm very humble for the good work that the breast surgeons are doing, is to not compromise the treatment or in any way elevate the risks for recurrence or mortality. There are many studies and we have a done big study in Stockholm with 300 patients with an immediate breast reconstruction and matched controls, so women having only mastectomies, and we have shown that there is no significant higher risks for the compromised oncological outcome in patients with immediate breast reconstruction. That's the most important message for women when they are put into deciding whether they want an immediate breast reconstruction or not, not to compromise oncological safety.

So that is one thing, the other thing is what about quality of life and it also has been shown that quality of life if you choose the breast reconstruction is better, especially in young women with DCIS. There was a study in The British Journal of Surgery in August last year showing that.