Approximately 3.5-7% of all breast cancer patients have distant metastases at the time of initial diagnosis. In the past, advanced breast cancer was usually considered incurable, so clinical treatment was based on adjuvant radiation, chemotherapy and endocrine therapy, and surgery was mostly used for symptomatic relief rather than for curative purposes. However, recent retrospective clinical studies have overturned the notion that surgery does not improve the prognosis of primary metastatic breast cancer, and even the notion that metastatic breast cancer is incurable has been challenged. One group of metastatic breast cancers that is most likely to benefit from aggressive combination therapy, characterized by a single, small number of detectable metastases confined to a single organ, is estimated to represent 1-10% of all newly diagnosed metastatic breast cancers in the stage IV breast cancer population with potential cure. The first consensus of the European Society of Medical Oncology (ESMO) Clinical Guidelines for Oncology (NCCN) and the European Society of Medical Oncology (ESMO) includes surgery, radiotherapy and chemotherapy. For example, patients with only one isolated metastatic lesion are able to achieve complete remission and long-term survival. Such patients should be treated more aggressively with multidisciplinary and comprehensive treatment.” The ESO-MBC Working Group retains these consensus recommendations in light of the reports suggesting that aggressive treatment can help improve tumor-free survival and overall survival in this particular breast cancer population. The significance of aggressive surgical treatment for primary metastatic breast cancer remains controversial, as there are only a handful of prospective clinical trials, approximately five, and no available data. The available data are limited to retrospective studies in which 33-61% of patients with stage IV breast cancer involved in these studies underwent resection of the primary lesion with an overall hazard ratio (HR) of 0.65 (95% CI: 0.59-0.72), which can be interpreted as a 35% lower risk of death from the disease in patients with advanced breast cancer who underwent aggressive surgery than in those who did not. Overall, younger patients, smaller tumors, single or few metastases or limited to a single area, no visceral metastases, and negative surgical margins tend to benefit survival, and axillary debridement also contributes to improved survival. In the past decade of clinical work in breast cancer surgery, I have encountered many cases of primary metastatic breast cancer, some of which were treated with chemotherapy or endocrine therapy alone, and some of which were treated with aggressive surgery on the basis of combination therapy, with mostly satisfactory results. In one case, the patient was 46 years old at the time of consultation in 2009 and was not yet menopausal. She was admitted to the hospital because she had “found a lump in her left breast for two months” and examined an 8*7 cm lump in the central area of her left breast, invading part of the epidermis. No signs of visceral or bone metastasis were found. After three cycles of preoperative chemotherapy, the tumor shrank by half and left mastectomy + left axillary lymph node removal + left cervical lymph node removal was performed, followed by four cycles of postoperative adjuvant chemotherapy and radiotherapy, and the patient has been tumor-free for more than six years. Another patient was 69 years old at the time of consultation in 2012, and had been menopausal. She was admitted to the hospital because she had “found a lump in her left breast for one year”. Bone scan revealed metabolic activity in some thoracolumbar vertebrae and abnormalities in the right occipital bone, but MRI failed to confirm metastasis. After four cycles of preoperative chemotherapy, the tumor shrank by more than half, and he underwent left mastectomy + left thoracic myomectomy + left axillary lymph node removal + left cervical lymph node removal, six cycles of postoperative adjuvant chemotherapy and radiotherapy, followed by endocrine therapy. Tumor conditions vary greatly, so of course, we cannot make a generalization. My belief is that as long as the conditions allow, the case is properly selected and the treatment plan is comprehensive and reasonable, some advanced breast cancers that were considered incurable in the past may achieve unexpected results through active treatment.