Breast conserving therapy (BCT) for breast cancer aims to achieve long-term local disease control with reduced local morbidity. BCT has similar long-term survival outcomes to mastectomy in patients with early breast cancer and recent studies have reported similar rates of recurrence compared with mastectomy. An increasing number of studies have shown improved overall survival among women treated with BCT regardless of cancer phenotype compared with mastectomy. Despite BCT being at least equivalent in outcome to mastectomy many women with small breast cancers continue to be treated by mastectomy and several studies in the last decade have shown a trend of increasing numbers of unilateral and bilateral mastectomies. The advent of increasingly effective neoadjuvant treatment has allowed even more women to have breast conservation. Not only has neoadjuvant therapy been shown to increase the rates of BCT, it does so without increasing in breast recurrence rates. Patients who are suitable for BCT should be advised that BCT is the best treatment option for them. They should be informed that not only does it confer at least equivalent survival and local recurrence rates but that compared with mastectomy it has the advantages of less complications, better quality of life and many less operations if reconstructive surgery is performed. It may no longer be appropriate to offer women suitable for BCT the choice of mastectomy or BCT.