Breast cancer detection and staging are constantly evolving as technologies improve. Breast cancer surgery is also undergoing continuous refinement, with the objective being to achieve optimal cosmetic results. Surgery has been combined with intraoperative radiation therapy to achieve the best local-disease control with minimal side-effects. The adjuvant strategy of treatment is a 'hot' issue in this 'scenario'. Every 2 years at St Gallen, a nice and cold town in the north of Switzerland, more of 4000 breast cancer experts arrive from every part of the world, to improve their knowledge in this issue. The Consensus Conference with the discussion of 40 international panelists is the zenith of the conference. This report provides a brief presentation and reflections, immediately at the end of the conference, with the objective being to stimulate ideas regarding what should be done tomorrow.