The treatment of breast cancer is an evolving field. Different modalities are continuously being developed to maximize patient survival while minimizing the treatment’s morbidity. Currently, the two main options for the management of primary breast cancer are total mastectomy and partial mastectomy with radiation. Although partial mastectomies (lumpectomy or quadrantectomy) conserve the nipple and areola complex and native breast tissue, asymmetry and distortion of the breast can still occur. Many methods of reconstruction have been described. The early and long-term effects of radiation also contribute to the complexity of these cases. This article reviews breast-conserving therapy, reconstruction options, and outcomes.