HER2-positive breast cancer benefits from targeted therapies like trastuzumab, but resistance remains a challenge. Antibody-drug conjugates (ADCs), combining cytotoxic agents with antibodies targeting HER2, offer a promising solution. Two ADCs, trastuzumab-emtansine (T-DM1) and trastuzumab-deruxtecan (T-DXd), are FDA-approved, with others in development. These ADCs aim to overcome resistance through innovative structures, mechanisms of action, and strategies to bypass resistance mechanisms, enhancing treatment efficacy for HER2-positive cancers.