Background <p>Breast surgical oncology was the most competitive surgical fellowship match in 2025, with a record low of 61% of applicants successfully matched. Previous studies evaluated the attitudes of program directors on the selection and ranking criteria of candidates. This study evaluates the perspectives of both program directors and associate program directors on the selection and ranking process because of the increasing competitiveness of the field.</p> Methods <p>An anonymous, web-based survey was sent to all breast surgical oncology fellowship program leadership. The survey consisted of 24 questions. Survey analysis was performed using descriptive statistics.</p> Results <p>Of 65 programs, 76.9% responded; 50 program directors and 26 associate program directors participated. Over half of programs (57.9%) engaged in holistic review of applicants before offering an interview and did not have formal screening criteria. For most programs (84%), additional faculty members beyond program leadership contributed to the rank list. Interview performance was the most important factor (65.8%) in the formation of the rank list.</p> Discussion <p>Compared with prior years, breast surgical oncology fellowship directors reported fewer screening metrics before extending an interview. In rank list formation, there continues to be a strong majority consensus with previous years and among other surgical subspecialties that interview performance has the largest impact. An improved understanding of the application and rank list process enables both applicants and program directors to better prepare for a successful match.</p>