Neoadjuvant chemotherapy has the potential to convert inoperable breast cancer into operable disease; however, patients may remain inoperable by the classic criteria after neoadjuvant chemotherapy. In such cases, palliative surgical therapy to promote comfort and hygiene and to control wound breakdown may need to be considered. This report documents this clinical scenario in a patient with a large exophytic breast cancer who had a partial response with neoadjuvant chemotherapy and required an extended radical mastectomy with extensive reconstruction for coverage. The decision to undertake such a surgical procedure is complicated when the patient's life expectancy may be extremely limited and both patient and treatment team must carefully weigh the risks and potential benefits of a highly complex but technically feasible operation.