Oncoplastic surgery refers to several surgical techniques by which segments of malignant breast tissue are removed to achieve wide surgical margins while the remaining glandular tissue is transposed to achieve the best possible cosmetic outcome. We summarise the general approach to oncoplastic lumpectomy for surgeons who recognise the limitations of standard lumpectomy for large breast cancers, and review different cancer distributions in the breast and their associated imaging characteristics. Full-thickness fibroglandular excision of the mass and surrounding breast tissue allows resection with wide surgical margins. Subsequent breast-flap advancement (mastopexy) results in closure of the resulting surgical defect with good or excellent cosmetic closure. These approaches can improve both the aesthetic outcome of breast cancer resections and the likelihood of surgeons obtaining wide surgical margins in preparation for breast-conserving radiotherapy. Advanced volume-displacement techniques, which are based on the key principles of breast reductive surgery, can greatly increase the options for breast conservation in complex cancer cases.