The EWS Managed API makes some tasks really easy – like replying to an existing email. Given the unique id of an item, this can be done this way:

var message = (EmailMessage) Item.Bind(service, new ItemId(uniqueId), PropertySet.FirstClassProperties);
var reply = message.CreateReply(false);
reply.BodyPrefix = "Response text goes here";
reply.SendAndSaveCopy();

But what if you want to send an attachment along with the reply? This is tricky, because the the instance created by the EmailMessage.CreateReply() method is of type ResponseMessage. Since its not an EmailMessage instance, it does not have an Attachment property. To add an attachment to this reply, it needs to be saved first. The Save method returns an EmailMessage instance. Attachments can be added to this message. Finally, the message can be sent to its destination.

var message = (EmailMessage) Item.Bind(service, new ItemId(uniqueId), PropertySet.FirstClassProperties);
var reply = message.CreateReply(false);
reply.BodyPrefix = "Response text goes here";
var replyMessage = reply.Save(WellKnownFolderName.Drafts);
replyMessage.Attachments.AddFileAttachment("d:\\inbox\\test.pdf");
replyMessage.Update(ConflictResolutionMode.AlwaysOverwrite);
replyMessage.SendAndSaveCopy();