Metastatic breast cancer is usually an incurable disease and surgery of the primary site was not believed to prolong life in patients presenting with stage IV breast cancer. This article is based on a review of relevant publications published from January 2000 to May 2010 with data on the possible impact of breast surgery in stage IV breast cancer on treatment results. Recent studies show a significant survival benefit from breast surgery in metastatic breast cancer patients. In the majority of the papers radical surgery (wide local excision or mastectomy) was shown to be correlated with improved survival (median survival time in patients operated on was nearly double in many studies). A minority of studies did not show any benefit from surgery or attributed the benefit to other factors (mainly preoperative chemotherapy). Randomized controlled studies to clarify the potential role of local breast surgery in this setting are currently underway.