<p>Breast cancer is one of the most prevalent malignancies among women worldwide, with brain metastasis occurring in approximately 10–16% of cases, significantly contributing to poor prognosis and reduced quality of life. The treatment of breast cancer brain metastasis requires a multidisciplinary approach, prioritizing local therapies such as surgery and radiotherapy to address central nervous system lesions. However, local treatments often struggle to effectively control the progression of brain metastases and are associated with multiple complications, necessitating adjunctive systemic and supportive therapies. Following local therapy, breast cancer brain metastasis patients may benefit from systemic treatments. Pharmacological therapies, including chemotherapy, targeted therapy, immunotherapy, and antibody–drug conjugates, have emerged as vital strategies for breast cancer brain metastasis treatment. Targeted therapies combined with stereotactic radiosurgery and surgical resection have shown improved survival rates. However, challenges remain, such as high costs, limited availability of radiotherapy equipment, and individualized treatment requirements based on lesion characteristics and systemic disease control. Further advancements in pharmacological options, particularly targeted and immune therapies, offer promising avenues for improving outcomes and survival in breast cancer brain metastasis patients.</p>