Roughly 70 % of all patients with breast cancer can be treated by breast-preserving procedures under optimal circumstances. Risk factors for the development of local recurrences are age, angioinvasion, poor differentiation of the tumor, negative steroid hormone receptors, extensive intraductal component and positive margins. Contraindications for breast preservation are large tumors without remission after preoperative chemotherapy, multicentricity, extensive intraductal component, large ductal carcinoma in situ, inflammatory breast cancer after preoperative chemotherapy, Paget disease and local recurrence after breast-conserving surgery. Preoperative needle biopsy allows determination of nearly all of the risk factors. To further increase the rate of breast conservation, preoperative chemotherapy should be used more extensively.