Breast cancer remains the most commonly diagnosed cancer among women in the United States, with many women diagnosed in early stages of disease. Many of these patients will receive surgical treatment alongside systemic therapies. Surgery, consisting of removal of the impacted tissue and, when indicated, axillary staging, can be accompanied by reconstructive procedures. Decisions around surgical approach for early-stage disease are influenced by extent of disease and patient preference. Clear communication regarding surgical options for early-stage, locally advanced disease can help patients make treatment choices consistent with their priorities.