Beat Thürlimann, MD, Cantonal Hospital St. Gallen, St. Gallen, Switzerland, and Michael Knauer, MD, PhD, Breast Center Eastern Switzerland, St. Gallen, Switzerland, outline the key topics discussed at the St. Gallen International Breast Cancer Consensus Session 2021. The renowned biennial consensus determines the optimal treatment of women with early breast cancer for the following two years. Prof. Thürlimann and Dr Knauer discuss the major loco-regional treatment topics from the session, including axillary dissection, omission of surgery after neoadjuvant chemotherapy, major changes in radiotherapy, and reoperation. This interview took place during the 17th St. Gallen International Breast Cancer Conference.