Neoadjuvant chemotherapy (NAC) is widely used as an efficient breast cancer treatment. Ideally

a pathological complete remission (pCR) can be achieved. With improvements in molecular typing guided NAC and targeted therapies

there has been dramatic improvement in pCR rates

especially among triple-negative and human epidermal growth factor receptor 2-positive breast cancers. Rates of pCR in these groups of patients can reach 60% or higher. NAC has significantly promoted the loco-regional de-escalating treatment of breast cancer. However

the need for breast surgery in NAC cases with pCR has been questioned

especially in the patients undergoing breastconserving surgery with whole breast radiotherapy. The main impediment to potential elimination of breast surgery is that conventional and functional breast imaging techniques are incapable of accurate prediction of residual disease. However

imaging-guided minimally invasive biopsy techniques might have the potential to overcome this impediment. This review summarizes the progress in selective elimination of breast surgery after NAC for breast cancer.