Abstract: Pregnancy and fertility issues are substantial concerns for the young breast cancer survivor, yet the available literature is hampered by a lack of prospective clinical studies and meaningful long-term outcome data. A lack of reliable information often leads to physician discomfort and patients may be left to navigate the world of fertility preservation and reproductive technology on their own. This case exemplifies some of the many issues that breast cancer survivors may face and adds another dimension to the survivor's dilemma; once fertility options have been preserved, what is the best method to sustain the pregnancy—self or surrogate? For many, the goal of balancing optimal treatment and long-term survival with restoration of a complete quality of life, including childbearing, may be attainable. This discussion highlights the importance of offering young breast cancer patients an opportunity to discuss these issues with their health care providers prior to initiating therapy.