Since the 21st century, systemic adjuvant therapies for breast cancer such as chemotherapy, endocrine therapy and targeted therapy have developed rapidly, and the concept of comprehensive treatment has taken root, but surgery still plays a dominant role in the treatment of breast cancer. a retrospective analysis of EBCTCG in 2005 showed that local recurrence at 5 years after surgery increased the rate of death due to disease at 15 years, suggesting that local treatment does affect patient survival. Choosing the correct surgical scope to minimize local recurrence may improve overall patient survival. Unlike in the past, when most breast tumors were found to be large, locally advanced masses with distant metastases, the proportion of small, inaccessible tumors or even ductal carcinoma in situ with calcifications has gradually increased with increased patient awareness and the use of mammography screening, resulting in a fundamental change in the surgical treatment of breast cancer. Breast-conserving surgery with radiotherapy has become the standard surgical treatment for early-stage breast cancer. With the support of oncoplastic surgery techniques, the indications for breast-conserving surgery are gradually expanding. Genotyping studies of breast cancer have revealed that breast cancer is the sum of a large group of diseases with different biological characteristics. Triple-negative breast cancer has a high rate of local recurrence after surgery, but is not a contraindication to breast-preserving surgery. For patients with positive lymph nodes, conventional breast-conserving treatment that includes radiation therapy may be more effective than mastectomy without radiation therapy. A study based on the SEER database compared two groups of patients with 1-3 lymph node metastases, 12,693 of whom underwent breast-conserving surgery plus radiotherapy and 18,902 of whom underwent mastectomy without radiotherapy. 15-year mortality from breast cancer due to disease was significantly lower in the breast-conserving treatment group than in the mastectomy group. Axillary lymph node status is an important predictor of breast cancer patients. Although axillary lymph node dissection surgery and radiotherapy to the axilla significantly reduced the recurrence of axillary lymph nodes in breast cancer and achieved good local lymph node control rates, they may also carry significant postoperative complications. In the Fisher era, the primary goal of axillary lymph node dissection was to provide staging and prognostic information to guide systemic therapy; the secondary goal was to achieve a reduction in local recurrence and a possible survival benefit. With the advancement and development of techniques that reduce many of the complications associated with axillary lymph node dissection, sentinel lymph node biopsy is gradually replacing conventional axillary lymph node dissection as a means of staging and even treatment of axillary lymph nodes. Long-term follow-up results from the NSABP B-32 trial have shown that sentinel lymph node biopsy can accurately predict axillary lymph node status and that axillary lymph node dissection can be safely avoided in patients with negative sentinel lymph node biopsy results. As the number of sentinel lymph nodes decreases and the level of pathological examination improves, positive sentinel lymph nodes can now be classified into three conditions: macrometastases, micrometastases and isolated cell clusters. The prognostic significance of sentinel lymph node metastases and the appropriate local versus systemic treatment are still controversial. The timing of performing sentinel lymph node biopsy after neoadjuvant chemotherapy, when some patients change from positive to negative axillae, needs further study. In conclusion, the scope of surgery for breast cancer continues to show a trend of gradual reduction, and the ideal outcome is to end surgical treatment of breast cancer with mastectomy and sentinel lymph node biopsy. The future surgical treatment of breast cancer has become an important issue in how to further reduce the trauma associated with surgical treatment and improve the quality of life of patients without reducing the therapeutic outcome. Controlling local recurrence and ensuring good postoperative cosmetic results are the two most important issues in breast preservation surgery. The amount of normal breast tissue removed around the tumor should be balanced between the two. Through the application of new examination tools such as breast MRI, the lesion can be accurately localized for surgical excision, and more intraoperative detection tools can be used to accurately assess the status of the intraoperative incision margin. The cosmetic outcome of the postoperative breast can be significantly improved by cosmetic techniques. Increased biopsy rate of anterior lymph nodes reduces surgical complications such as upper limb lymphedema and sensory abnormalities associated with unnecessary axillary lymph node dissection. Multidisciplinary participation in the treatment process of breast cancer, based on the analysis of gene expression profiles, to achieve truly individualized treatment goals. The future resolution of all these issues depends on providing more information and important evidence-based medical evidence to guide the surgical treatment of breast cancer through the careful design and conduct of new prospective randomized controlled clinical trials.