In literature a lot of different approaches for breast conservation surgery have been recommended. Until now little prospective research has been done to identify the role of these variations on outcome. Within a group of surgeons participating in the same clinical trials, which give a number of specific directions, already a lot of variations in techniques are detected. This pinpoints two questions: firstly, what differences could be detected in non specialised general practices and secondly, which of those variations are important to be standardised. The documentation of the predetermined important technical factors and the development of clear guidelines for surgery are essential to implement a process of quality audit. This will probably be the best stimulus to raise treatment quality in breast cancer patients.