Ultrasound is a great ally for radiologists, a fast and versatile guidance for breast diagnostic and interventions, with the advantage of real time view of the procedures and better outcomes. Selecting the most appropriate technique for U/S biopsies can help reduce underestimations, even in challenging cases, while the extended use to completely excise benign lesions and B3 lesions can avoid unnecessary surgeries, with important decrease of costs and patient’s stress and physical discomfort. Furthermore, recent studies suggest that VAB might reliably exclude residual cancer in patients who underwent neoadjuvant chemotherapy with radiological complete response and, if the preliminary results are confirmed on a wider scale, in future settings ideally avoid surgery. The availability of breast tissue markers with high ultrasound visibility enables smoother and faster pre-surgical marking under ultrasound guidance on all lesions, in the Radiology Department or directly in the operating room, with significant advantages to the patient and the whole work flow.