Triple-negative breast cancer (TNBC) is an aggressive subtype often treated with neoadjuvant therapy (NAT). The KEYNOTE-522 regimen, incorporating pembrolizumab with chemotherapy, has shown promise in improving pathologic complete response (pCR) rates. This study analyzed outcomes of 30 TNBC patients treated with the KEYNOTE-522 regimen in a real-world setting, focusing on surgical and oncologic outcomes. A retrospective analysis was conducted on patients treated between January 2022 and February 2024. Data included demographics, tumor characteristics, genetic findings, treatment complications, and pCR rates. Immune-related adverse events (irAE) and post-operative complications within 30 days were recorded. The average age at diagnosis was 47 years, with most patients (81.5%) presenting with self-detected lesions. Average tumor size reduced from 37 mm pre-treatment to 4 mm post-treatment. Nine patients had genetic mutations, including 5 with BRCA1/2 mutations. Six patients experienced irAEs, including 3 cases of hepatitis; 2 patients with hepatitis were unable to complete NAT. Surgical outcomes included 20 breast-conserving surgeries (BCS), with 6 advanced reconstructions, and 7 mastectomies. Axillary node dissection (ALND) was performed in 7 patients, and targeted axillary dissection (TAD) in 9. pCR was achieved in 24 patients (80%). Average time to surgery post-NAT was 22 days, and the average hospital stay was 2.4 days. Complications included wound necrosis (1 patient) and chyle leak (1 patient). The KEYNOTE-522 regimen demonstrated an 80% pCR rate, aligning with prior clinical trials, and supporting its efficacy in real-world TNBC treatment. Larger studies are needed to validate these findings.