The 19th St. Gallen International Breast Cancer Conference took place at the Austria Centre in Vienna from March 12th to 15th, 2025. The event achieved remarkable success, drawing over 3,100 participants from all over the world. This accomplishment is attributable to the high calibre of scientific lectures presented by leading global experts in breast cancer (BC) treatment, the opportunity for the audience to interact with panellists through questions, the interesting and varied scope of submitted posters, the debates that punctuated the many sessions, and notably, the renowned St. Gallen Consensus Session. This year's Opening Ceremony held particular significance. In commemoration of the Swiss physician and oncologist Hansjoerg Senn, who passed away in 2023, the Hansjoerg Senn Memorial Lecture was instituted to honour his profound contributions to the treatment and care of patients, particularly those affected by BC. The Memorial Lecture serves as a platform to recognise and celebrate individuals who have significantly advanced BC research. The recipient is presented with the St. Gallen Breast Cancer Award and invited to deliver an address at the opening ceremony of the St. Gallen International Breast Cancer Conference. This year, this prestigious award was presented to Prof. Armando E. Giuliano, who delivered an insightful lecture entitled ‘My Personal Experience: Changing Surgery for BC.’ In it, drawing from his impressive surgical career during which he changed the standard of care—exemplified by the sentinel lymph node procedure and the Z0011 study—he spoke about how change, though difficult, is both necessary and inevitable, emphasising that no one is too young or too old to change.