The increasing incidence of breast cancer and advances in detection of small, impalpable cancers presents increasing challenges for the modern breast surgeon. Accurate localization and excision with adequate oncological margins to reduce loco-regional recurrence rates whilst minimizing volume deficit and maximizing aesthetics remains the “gold standard.” We review the current techniques available and the developments within this field. J. Surg. Oncol. 2014 110:21–25. © 2014 Wiley Periodicals, Inc.