There is great heterogeneity in clinical practice regarding surgical intervention for the primary breast tumor and axillary nodes among patients with simultaneous distant metastases. Numerous retrospective series suggest a survival benefit in patients undergoing both surgery and radiation, and some of these studies have withstood the test of multivariate analysis to control for potentially confounding variables. A subset of patient may benefit from primary tumor treatment which includes axillary clearance and post operative radiotherapy. Estrogen receptor and Her2nu status are predictive for improved survival. Visceral metastases are associated with poorer survival. Regardless of receptor status, surgery resulted in excellent local control (5% local relapse rate).