Purpose of the Review <p>This review explores the evidence supporting tailoring of breast surgery, axillary surgery, and radiation therapy following a pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC). The goal is to identify how to best predict treatment response and when subsequent local therapy can be safely de-escalated.</p> Recent Findings <p>Advances in systemic therapy have increased pCR rates, particularly in aggressive breast cancer subtypes. Emerging data suggest that patients experiencing pCR may not benefit from extensive surgery or radiation. Imaging, biopsy, and molecular profiling techniques show promise in accurately identifying pCR and guiding individualized treatment plans.</p> Summary <p>Patients with confirmed pCR after NAC may safely undergo less extensive local therapy. Incorporating molecular and imaging biomarkers into clinical decision-making may optimize patient selection, reduce morbidity, and shape future strategies toward more personalized, minimally invasive breast cancer care.</p>