<p>Breast cancer is one of the most common and deadly types of cancer in women, and its treatment is associated with several challenges, including drug resistance, drug side effects, and inadequate targeting of cancer cells. In recent years, the use of exosomes as natural drug carriers has attracted much attention due to their properties such as high biocompatibility, ability to cross biological barriers, and ability to target specific cells. Targeted exosomes, by surface modification and loading of chemotherapeutic drugs, regulatory RNAs, and other therapeutic molecules, enable more effective drug delivery and reduce systemic toxicity. This review article will examine the role of targeted exosomes in improving drug delivery in breast cancer in a narrative manner. First, the structure and biological properties of exosomes and different drug loading methods are described. Then, the preclinical and clinical applications of exosomes in the delivery of various drugs and their effects on cancer cells and cancer stem cells are reviewed. The main challenges in the use of exosomes are also discussed, including standardization of isolation and detection methods, precise control of drug loading, unfavorable stability and biodistribution, and issues related to mass production and safety. Finally, the future prospects of this field are discussed, focusing on novel exosome engineering technologies, combination with immunotherapies, and development of more precise targeting methods. This review shows that targeted exosomes have great potential to improve the efficacy of breast cancer therapies, but further research and resolution of technical and clinical challenges are required for widespread clinical entry.</p>