This study evaluates the incidence, pattern and mode of detection of loco-regional recurrence (LRR) after conservative surgery for invasive breast cancer. Over an 11-year period, 354 patients were treated with wide local excision, axillary sampling and radiotherapy to the remaining breast. LRR occurred in 33 patients (9.3%). Local recurrence (LR) in the conserved breast occurred in 73% (24/33)of the patients while regional recurrence (RR) accounted for 9% (3/33). There were 6 (18%) patients with both local and regional recurrence. Recurrence was detected clinically in 85% (28/33) and mammographically in 15% (5/33) Of those patients who have had their recurrences detected clinically 61% (17/28) have died. None of the 5 patients with mammographic recurrences have died. Patients who develop LR after conservative surgery do better if the lesion is detected mammographically compared with those detected clinically (P < 0.03, Fisher's exact test). Mammography, in addition to regular clinical review, is an important aspect of the follow-up protocol after breast conserving surgery.