早期乳腺癌患者术后同侧乳腺肿瘤复发（IBTR）分为保留乳房手术后乳房局部复发和乳房切除术后胸壁的复发。IBTR包含来源于残留恶性肿瘤（原位癌或浸润癌）的真实局部复发和来源于残余乳腺组织的新原发肿瘤。复发的病理学本质可能与局部亚临床病灶的残留、既往辅助治疗耐药诱导的肿瘤细胞休眠等有关。目前临床上缺乏区分真实局部复发和新原发肿瘤的判定标准，已成为局部复发治疗的关键挑战。笔者回顾乳腺癌术后IBTR的临床病理学认知及复发的判别标准，并探讨早期乳腺癌孤立性IBTR的处理原则，认为（1）复发及转移的乳腺癌应归于晚期解救治疗的范畴；（2）复发状态下亚临床病灶及循环肿瘤细胞存在的可能性远高于首发时辅助治疗状态；（3）复发后系统治疗的选择更少，有效性更低，不可预测性更高，药敏试验尤为重要。因此，IBTR应首先考虑全身系统治疗，并基于循证医学证据区分真实局部复发和新原发肿瘤，在多学科团队诊疗基础上制定个体化治疗方案。

Ipsilateral breast tumor recurrence (IBTR) after surgical resection in early breast cancer (EBC) patients is categorized into local recurrence following breast-conserving surgery and recurrence on the chest wall after mastectomy. IBTR may represent a true local recurrence (TLR), from growth of residual malignancy (in situ or invasive) or a new primary (NP) tumor, arising in the residual breast tissue. The underlying pathology of IBTR may involve the presence of subclinical residual lesions and tumor cell dormancy induced by resistance to previous adjuvant therapies. Currently, there is a lack of standardized criteria to distinguish between TLR and NP tumors, which poses significant challenges in clinical management. We reviewed the current clinical pathological understanding and discriminant criteria for IBTR, explored the treatment principles for isolated IBTR after EBC, and make the following conclusions. (1) Recurrent and metastatic breast cancer should be regarded as advanced disease states. (2) The likelihood of subclinical lesions and circulating tumor cells being present in the recurrent disease state is much higher than during the adjuvant therapy stage at initial diagnosis. (3) Systemic therapy options after IBTR are often more limited, with reduced efficacy and increased unpredictability. Thus, drug sensitivity testing becomes particularly important. For IBTR, systemic therapy should be considered first. Based on evidence-based medicine, a multidisciplinary team (MDT) should distinguish between TLR from a NP tumor, and formulate an individualized treatment plan.