Neoadjuvant chemotherapy is chemotherapy used prior to definitive local treatment. There is more discussion on the choice of neoadjuvant chemotherapy regimen and the duration of chemotherapy, and less discussion on the subsequent local management. In this article, we present a review on the research progress of local surgical management after neoadjuvant chemotherapy. Selection of breast-conserving surgery after neoadjuvant chemotherapy The aim of neoadjuvant chemotherapy is to strive for breast-conserving surgery (BCS) through downstaging, and the selection criteria for BCS should be consistent with direct surgery. large size, lymph node metastasis, residual multiple lesions after chemotherapy and lymphovascular invasion. Contraindications to breast conservation after chemotherapy include: residual tumor larger than 5 cm, skin involvement, presence of diffuse calcification on post-chemotherapy molybdenum imaging, multicentric tumors, and contraindications to radiation therapy. Studies have shown that BCS after neoadjuvant chemotherapy for locally advanced disease does not have a significantly different local recurrence rate compared to conventional BCS for early breast cancer.In the M.D. Anderson study of BCS after neoadjuvant chemotherapy in patients with LABC, with a median follow up time of more than 6.6 years, the rate of local recurrence was 2.7% and the rate of intramammary recurrence was 1.8%. Therefore, breast-conserving surgery is also considered for LABC patients who respond well to neoadjuvant chemotherapy. Neoadjuvant chemotherapy works differently for different types of breast cancer, which will affect the feasibility of BCS. Large, non-microcalcified unifocal tumors are the best indication for BCS after chemotherapy, but silver clips are needed to mark the extent of the tumor bed before or between chemotherapy sessions. If the lesion shrinks in a concentric circle fashion after chemotherapy with short distances between silver clips, these clips can be removed en bloc in a single procedure. Invasive lobular carcinoma has a slower response to chemotherapy, making it difficult to successfully downstage to meet the requirements of BCS. Patients with inflammatory breast cancer with diffuse microcalcifications or multicentric tumors with diffuse suspicious microcalcifications require mastectomy regardless of chemosensitivity. 2. Immediate breast reconstruction after neoadjuvant chemotherapy With the improvement of breast cancer treatment level and plastic surgery technology, there have been attempts to perform immediate breast reconstruction (IBR) for patients with LABC, but its safety has yet to be confirmed, such as the damage of radiotherapy to the reconstructed breast, whether postoperative radiotherapy is necessary, and the possible delay of postoperative adjuvant therapy by IBR. delay postoperative adjuvant therapy. Radiotherapy is part of the standard treatment for LABC, but is also considered a contraindication to IBR. The most common complication is implant contracture, and Cordeiro et al. reported that the rate of contracture was higher after radiotherapy (68%) than in patients without radiotherapy (40%), and nearly half of the patients treated with radiotherapy were forced to have their implants removed as a result.Soong et al. concluded that autologous tissue-recreated breasts can tolerate a dose of 50 Gy of radiotherapy better. There have also been reports of good results of breast reconstruction with TRAM flaps immediately after radical surgery, but delayed breast reconstruction should be considered because postoperative radiotherapy is usually necessary in patients with LABC, and delayed fibrosis and contracture may occur after radiotherapy with TRAM flaps. It is important to determine preoperatively whether a patient requires postoperative radiotherapy.ASCO recommends postoperative radiotherapy for patients with four or more lymph node metastases who have not undergone neoadjuvant chemotherapy. Patients with residual or drug-resistant lesions after chemotherapy may be treated with radiotherapy to increase the rate of local control, and therefore all patients with LABC should be treated with radiotherapy regardless of the response to chemotherapy, regardless of conservative or aggressive treatment regimens. However, in patients with only microscopic or even no residual lesions in the breast or axilla after chemotherapy, it is uncertain whether regional lymph node radiotherapy would be of benefit. data from the M.D. Anderson Oncology Center show that pre-chemotherapy staging predicts the risk of local recurrence even in patients who are in complete remission after neoadjuvant chemotherapy and suggests that this is the basis for deciding whether or not radiotherapy is needed, and that what is seen pathologically is extremely important in deciding whether or not to give radiotherapy postoperatively , but it is not possible to make an accurate prediction preoperatively. Therefore, the complete treatment plan, including the final radiotherapy plan, should be discussed from a multidisciplinary perspective for each patient. In the study by Mortenson et al, wound complications were more frequent in patients with IBR (22.3%) than in those without reconstruction (8.3%), but were milder and could be quickly managed without delaying radiotherapy. In addition Newman et al. noted that the interval between adjuvant therapy and IBR did not affect the rate of recurrence. Kronowitz et al. at the M.D. Anderson Oncology Center proposed a “delayed-immediate” approach to breast reconstruction: the patient undergoes a skin-sparing mastectomy with implantation of a tissue expander to “take up space,” and, pending pathologic results, the patient is treated with PMRT. Breast reconstruction can be performed immediately if PMRT is not required, or delayed after radiotherapy if PMRT is required. This method can be used for any patients with unknown indications for PMRT but require immediate reconstruction, which meets the aesthetic requirements and ensures surgical safety, and is a method with practical application value, but more practical verification is needed. 3, Sentinel lymph node biopsy after neoadjuvant chemotherapy In the last decade, lymphatic imaging and sentinel lymph node biopsy (SLNB) techniques have been used to perform axillary staging, and the accuracy and safety of SLNB for patients with early-stage breast cancer have been confirmed by a large number of literatures [10], but it is not yet known whether SLNB is accurate after neoadjuvant chemotherapy. Some studies have suggested that the diagnosis of SLNB before neoadjuvant chemotherapy.