With recent advances in technology and increased use of ultrasound, breast surgery has dramatically changed its approach towards nonpalpable lesions. Several image-guided diagnostic and therapeutic procedures have been implemented for the treatment of breast disease. Some of these modalities, including percutaneous image-guided biopsy techniques, were developed for the management of nonpalpable lesions, and they have been incorporated as the current standard of practice. Other innovating image-guided technologies, such as radiofrequency ablation and cryoablation therapy, are being explored in clinical protocols as promising new treament modalities. In this article, the authors review the indications, advantages, and application techniques of the most common and current image-guided procedures performed today for the approach of breast pathology.