Surgical treatment of locally advanced or recurrent breast cancer involving the chest wall continues to play a role in the therapeutic armamentarium as part of the multidisciplinary treatment regimen. Significant progress has been made in chest wall resections and reconstructions, thanks to the availability of novel materials and tissue transfer methods. The understanding of cancer biology and behavior, and novel drugs further improved the field. Patient selection and superb knowledge of the most recent and effective treatment options are necessary to maximize the survival benefit and quality of life for patients affected with breast cancer involving the chest wall.