Purpose: Neoadjuvant chemotherapy (NACT) is standard protocol for locally advanced, Her-2 positive or triple negative breast cancers. Increasingly, studies are investigating descalation of surgical intervention in these patients as it improves cancer outcomes as well as improves psychological and quality of life outcomes for patients. Clinical and radiological assessment is needed to monitor response to chemotherapy in order to determine if patients are safe and suitable for consideration of surgical descalation.   Methodology: We completed a retrospective, observational, cohort analysis of patients who underwent both NACT and surgical intervention at our tertiary, metropolitan institution. Cases were identified through presentation at our Breast MDT between Jan 2024 and Jan 2026. Their demographics, comorbidities, pre NACT cancer information, post NACT imaging and operative management were recorded. Those who underwent post NACT imaging were assessed for correlation and consistency with their final histology.   Results: Fifty-nine patients were identified through the MDT who met inclusion criteria. Of these 59 patients, 32 (54.2%) had post NACT imaging of some form. Patients who were imaged post NACT were more likely to be PR negative (46% vs 53%, p=0.037), Her-2 positive (56.3% vs 53.8%, p=0.065) and have pembrolizumab as part of their treatment (53.8% vs 12.5%, p= 0.045). Breast conserving surgery was achieved in 51.5% of post NACT radiology patients compared to 42.3% of those without (p=0.60). 2 in the group with radiology had reconstruction vs 5 who were not imaged. The consistency of findings on MRI with final histology was 50% (p=0.42) and with ultrasound was 60% (p=0.16).   Conclusion: Consistency of imaging and histology responses was lower than acceptable for clinical decision making, potentially being attributed to variability of utilisation of post NACT imaging in the cohort.