From 1977 to 1987, 23 patients with isolated chest wall recurrence, excluding sternal metastasis, from breast cancer underwent full thickness chest wall resection. The 5-year survival rate after chest wall resection was 48%, but the 5-year relapse-free survival rate was 26%. Mediastinal metastasis was proved histologically at the time of chest wall resection in 7 patients, and survival period with mediastinal involvement was significantly (P < 0.01) shorter than that with no mediastinal involvement (n = 16). In 17 patients with a long disease-free interval (DFI greater-than-or-equal-to 24 months), survival was longer than in 6 patients with a short DFI (< 24 months). For the selected patients without mediastinal involvement and long DFI, surgical treatment for chest wall recurrence of breast cancer should play a significant role in improving the quality of life, and even in prolonging the survival rate.