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Variability exists regarding the surgical technique in breast conservation therapy. The purpose of this project was to determine differences between single (SH) or flanking (FH) hooked needle localization wires used for nonpalpable breast lesions. We retrospectively reviewed 201 female patients at a single institution from 2004 to 2008. All patients had biopsy-proven ductal carcinoma in situ or invasive disease. Comparisons were made in regard to margin status, reoperation, completionmastectomy, size of lesion, and breast specimen volume. SHwas placed in 122 patients (61%) and FH in 79 patients (39%). In SH, 23 patients (18%) had positive margins and 31 patients (25%) had reoperations as compared with 31 patients (25%) with positivemargin and 36 patients (44%) in the FHcohort (P=0.039 and 0.0037).Average lesion size and volume resectedwas 1.5 cmand 137 cm³ in SH and 2.85 cm and 188 cm³ in FH, respectively (P = 0.0001 and 0.006). Positive margins were associated with lesion size and not volume of tissue excised. The FH technique was associated with more positive margins, reoperation, and completion mastectomy. [ABSTRACT FROM AUTHOR]