Counseling a woman about surgical treatment of breast cancer is both challenging and rewarding. The layperson's view of breast cancer surgery is that it is disfiguring, if not mutilating. Today's newer approaches are neither, and informing the patient of these options can relieve anxiety, improve outlook and help maintain the patient's self image. The surgical options for diagnosis and treatment of breast cancer are evolving. Minimally invasive biopsy techniques, (core needle biopsy) are becoming the standard for the diagnosis of breast cancer, replacing open surgical biopsy with its increased cost and large surgical scars. Sentinal lymph node biopsy is now considered the standard of care in evaluation of lymph nodes, compared to axillary lymph node clearance. Oncoplastic surgery improves cosmesis after breast conservation (lumpectomy). Skin sparing, areolar sparing, and nipple sparing mastectomies are becoming common approaches to mastectomy with reconstruction. Immediate reconstruction after mastectomy is now routinely performed with implants or autologous tissue. This article reviews these surgical approaches and will allow the primary care provider a better understanding and ability to counsel their patients in the options for surgical treatment of breast cancer.