Preoperative chemotherapy in 226 women with large breast cancers reduced tumour size sufficiently for breast conservation surgery, according to our criteria, in 203 patients (90%). After 50 months' mean follow-up there were 13/203 local relapses (5.3%). This approach is therefore effective but only if the breast can be conserved with good aesthetic result, otherwise mastectomy plus reconstruction is preferable. The type of surgery must be decided during operation after careful assessment of tumour regression, resection margins, tumour size in relation to breast size and extent of microcalcifications.