Nine patients with solitary sternal metastasis of breast carcinoma were treated aggressively, with partial (n = 8) or total (n = 1) resection of the sternum. Parasternal and mediastinal lymph node dissection also was performed concomitantly for every patient. Chest wall defects were reconstructed with acrylic resin plate (n = 3) or rectus abdominus myocutaneous flap (n = 6). All patients received chemoendocrine therapy postoperatively. The median survival of these nine patients was 30 months. The prognosis of the patients (n = 4) with the mediastinal or parasternal lymph node metastasis were poor and all of them died of second relapse within 30 months. The prognosis of those (n = 5) without the lymph node metastasis, however, was quite favorable; three survived more than 6 years. These results suggest that sternectomy should be indicated for the solitary sternal metastasis when no evidence of systemic spread is noted since it can improve the quality of life and occasionally may result in long-term survival.