Mammography is currently the primary imaging modality for post-operative evaluation and surveillance of the conservatively treated breast. Tumor recurrence has been shown to occur at a rate of approximately 1–2% per year, and the goal of imaging surveillance is to detect recurrent and new cancers at the earliest stages while avoiding unnecessary biopsies for characteristically benign findings. The radiologist should be familiar with the expected mammographic appearance and evolution of benign post-lumpectomy/post-radiation change, while also recognizing findings suspicious for residual and recurrent disease. This chapter, appearing in the section on intervention and surgical changes, reviews the key imaging and clinical features, imaging protocols and pitfalls, and clinical recommendations for the post-lumpectomy and post-radiation breast. Topics discussed include the evolution of benign post-surgical/post-radiation findings and the detection of suspicious lesions. The primary emphasis will be on mammographic surveillance. The role of ultrasound and MRI will also be discussed.