The longevity for patients with stage 4 breast cancer has improved over the years due to the advances in medical oncology, however breast reconstruction in this setting remains controversial. There have been few multicentre studies and numbers of patients are limited. This is indeed a difficult topic where the multidisciplinary team emphasises on the quality of life rather than quantity in patients with poor prognoses- thus there remains a hesitation on the part of the treating team to offer reconstruction. 11 leading medical centres in the US and Canada conducted a prospective cohort study where patient reported outcomes, PRO were assessed using the BREAST-Q, for patients with stage 4 disease undergoing reconstruction and comparing them with a control group of patients with stage 1 to 3 disease receiving reconstruction. It was encouraging to note that breast reconstruction offers significant QOL benefits especially improving the psychological well-being in patients with advanced breast cancer with no increase in post operative complications. The decision to pursue this in select few has to be balanced with the resources available, disease burden and expected overall survival. Such patients require support and counselling and should be consulted a few times to ensure they understand and appreciate if IBR is not advisable. In addition, access to a psychologist is vital as the process is likely to leave a disturbing lasting impact.

Miss Naseem is an experienced breast surgeon who practices the entire spectrum of breast surgery from oncological to aesthetic and benign breast conditions. Miss Naseem is passionate about medical education. She has over a decade of experience as a tutor and examiner, notably both nationally and internationally, of I MRCS, RCS England. In addition,  she also examines the breast fellowship for the European Board of Surgery Qualification.  Miss Naseem is actively engaged in the virtual mentorship programme to junior surgeons in the developing world, that is led by the RCSEngland. She is an honorary lecturer and surgical tutor for the Bristol Medical School, University of Bristol and a educational supervisor for foundation year doctors from South West deanery. She has also undertaken teaching sessions in her home country that was hugely appreciated. Miss Naseem has published numerous articles in peer-reviewed scientific journals, alongside being a peer reviewer herself. She takes immense pride in effective communication, and as a consequence, has researched and published on this subject. She has authored on communication and breast abscess in a medical textbook.