Purpose of review <p>Breast-conserving therapy (BCT) with radiotherapy and mastectomy have long been considered equivalent for early-stage breast cancer based on landmark trials demonstrating no difference in overall survival. Despite these findings, mastectomy rates remain high. We review the outcomes across different clinical subgroups undergoing breast cancer surgery.</p> Recent Findings <p>Current evidence supports BCT as an oncological sound approach across a broad range of clinical scenarios, including multifocal disease, diverse tumor subtypes, and patients treated with neoadjuvant therapy.</p> Summary <p>In more complex settings—such as hereditary cancer syndromes, pregnancy, or prior radiation—management should be individualized rather than defaulting to more extensive surgery. This review highlights current evidence supporting BCT and underscores the importance of personalized, evidence-based surgical decision-making aligned with tumor biology, disease extent, and patient preference.</p>