Since William Stewart Halsted performed the first radical mastectomy in 1882 in New York, surgery has remained the most important method in treating breast cancer. Along with research progress in our biological knowledge of breast cancer, the modality of surgery has evolved from radical mastectomy into modified radical mastectomy and breast conserving surgery. With regard to early breast cancer, axillary surgery has also evolved from complete axillary lymph node dissection to sentinel lymph node biopsy. In those patients who have undergone breast conserving surgery, it is no longer necessary to perform axillary lymph node dissection even if one or two sentinel lymph nodes are positive for H&E stain. In addition to being applied to early breast cancer, sentinel lymph node biopsy is also being gradually applied to other scenarios such as ductal carcinoma in situ, before or after neoadjuvant chemotherapy. Besides the therapeutic efficacy of breast cancer surgery, more and more effort has been put into how to maintain the patient’s body image after surgery. Furthermore, consensus has been growing as to the benefits of skin-sparing mastectomy, nipple areola complex preserving surgery, and oncoplastic surgery as data accumulates about the cosmetic benefits and oncologic safety of these procedures.