48-year-old female with a left breast lump and skin dimpling. Tomosynthesis shows an 18 mm mass in the lateral left breast (Figure 3a and b). Figure 3a and (bcorrelating with the clinical abnormality in a BI-RADS (c) (heterogeneously dense) breast. Ultrasound confirmed a hypoechoic solid mass suspicious for malignancy (Figure 3c). Ultrasound-guided 14G biopsy demonstrated Grade 2 invasive carcinoma (NST). Histology of the WLE specimen showed tumour involvement of the superior and medial margins and re-excision revealed persistent tumour involvement of the new resection margins. At this point, MRI was performed. MRI showed a 9 mm enhancing nodule at the site of surgery, suspicious for residual disease. A second lesion was seen remote from the surgical resection cavity in the lower outer quadrant, measuring 11 mm (Figure 3d). Second look ultrasound was normal, so MRI-guided biopsy was performed which confirmed invasive carcinoma with a similar histology profile to the original tumour. Completion mastectomy confirmed distant disease in the ipsilateral breast away from the surgical site. WLE, wide local excision.