The combination of radiation therapy (RT) and conservation surgery is appropriate treatment for Stage I and II breast cancer patients, and is equivalent to radical mastectomy in overall survival and recurrence free survival. Moreover, RT and conservation surgery has the advantage over radical surgery of breast preservation (and subsequent psychological advantage). Inherent in the preservation of the breast is the concept of cosmesis. This implies that the treated breast is not retracted or deformed by the surgery and radiation. Current studies indicate that there is an increase in complications and less satisfactory cosmetic effect on patients receiving chemotherapy in conjunction with conservation surgery and RT, but no effect on survival. This raises the question of which patients should receive chemotherapy and what type of chemotherapy should be used. It also raises the question of the initiation timing and dosage of chemotherapy.