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Breast cancer-related lymphedema (BCRL) can affect breast cancer patients, especially after axillary surgery and radiation treatment, for life. First line treatment is conservative and involves physical therapy and compression. It requires absolute, life-long compliance with treatment by the patient and, in some cases, it is ineffective. In recent years, surgery has emerged as a possible altative or even, complementary therapy for BCRL. The most commonly reported techniques are reconstructive or debulking procedures. Reconstructive procedures are aimed at restoring the lymphatic pathways and can be effective early in the disease process, when increased arm volumes are mostly due to the accumulation of protein-rich fluid in the interstitial space. In more advanced stages, where fibrotic and hypertrophic adipose tissues are dominant, debulking techniques such as liposuction can be recommended. A standard of care for the treatment of BCRL has not been established. Currently, different techniques can be combined to optimize clinical outcomes, and the surgical approach must be individualized for each patient, based on sound clinical and imaging assessment. BCRL surgical treatment remains a challenging topic that requires further study before it can be standardized.