Breast cancer is the most common malignancy in women in Western Europe and the U.S. Adjuvant chemotherapy reduces the rate of cancer recurrence, thereby contributing to the recent decline of breast cancer mortality. Notably, a number of important developments occurred over the past decades. Starting with first generation regimens like CMF, the next step was the introduction of anthracyclines into the adjuvant setting, although the role of these drugs is again dubious today. Modern regimens followed with the introduction of taxanes into the adjuvant setting, and a number of further developments are under way: Dose dense regimens as well as targeted therapies have led to a new era of treatment of women with early breast cancer. Neoadjuvant chemotherapy, while sometimes still debated, has increased the rate of breast conserving surgeries. Obviously, both neoadjuvant, therefore preoperative, and adjuvant chemotherapy have their specific advantages and drawbacks. This will be dealt with in detail. Also a short overview of available data on adjuvant chemotherapy in the elderly is provided. The history, recent developments, as well as open questions will be discussed in this review.