In the multidisciplinary treatment of locally advanced and metastatic breast cancer, aggressive surgical options can be chosen in selected cases. They may allow: survival to be prolonged by the resection of metastases (liver, ovary, lung), symptomatic treatment (bone pain, local recurrence, infiltration of the chest wall), prevention of potentially disabling complications (pathologic fractures, medullary compression), exclusion of another tumoural or non tumoural diseases. The decision to perform surgery has to be discussed between the surgeon and the oncologist so as to optimise its timing. Surgical treatment can follow induction therapy or can precede chemo- or hormonotherapy.