Abstract: Systemic therapy is usually the main treatment for patients with stage Ⅳ breast cancer at diagnosis. Surgical resection of the primary tumor is typically conducted for palliative reasons, and whether such treatment can benefit patients' survival outcome remains unclear. In our clinical practice, proper timing and indications for surgery of the primary tumor, as well as an appropriate surgical technique, may increase the success of local treatment for stageⅣ breast cancer. This article reviews available literature and discusses the role of surgical resection in the treatment of stage Ⅳ breast cancer at initial presentation.