Breast cancer is the second most common malignancy in women worldwide. Due to improvements in screening, diagnosis, endocrine therapy and novel targeted agents, survival continues to increase. The initial workup should include thorough imaging of the breast and nodal basins, pathologic review, receptor status analysis and systemic staging as necessary. This information is fundamental to determine the best options for surgery, systemic therapy and radiation therapy and in addition, the most appropriate sequence of multimodal therapy. Care of patients with germline mutations should include genetic counseling and consideration of prophylactic mastectomy and salpingo-oophorectomy. Recent advances in immunotherapy, targeted agents and antibody drug conjugates improve survival and quality of life for metastatic breast cancer patients while limiting toxicity. Surgical techniques have evolved to allow more patients to undergo breast conservation and to limit morbidities from axillary node dissections. New genomic predictive assays allow us to select high risk patients who will truly benefit from chemotherapy and radiation therapy. Modern radiation approaches can limit toxicities by using hypofractionation, partial breast irradiation, 3D conformal planning and proton therapy. The optimal treatment of breast cancer patients requires a multidisciplinary approach tailored to the individual patient in order to maximize clinical outcome and minimize toxicities.