Neoadjuvant therapy may provide advantages to some women with primary operable breast cancer. Compared to the administration of the same regimen in the adjuvant setting, neoadjuvant chemotherapy does not improve survival outcomes, but may provide other benefits. Neoadjuvant therapy is associated with improved rates of breast-conserving therapy, may offer prognostic information, and enables assessment of in vive response to therapy. Women who achieve a pathologic complete response following neoadjuvant therapy are expected to have a superior outcome compared to those with extensive residual disease. The neoadjuvant setting has been an attractive area of research for identifying new effective treatment strategies while minimizing treatment-related adverse events, studying drug mechanisms of action, and developing clinically applicable prognostic and predictive biomarkers in an attempt to individualize therapy. In the primary operable setting, it is of great importance to define treatment goals, to select proper candidates for the approach, to assess baseline tumor characteristics, and to provide optimal multidisciplinary monitoring during and following the neoadjuvant therapy.