Opinion leaders within the field of breast surgery, many of whom trained before the advent of breast-specific fellowships, have been instrumental in development of the new multidisciplinary training paradigm. In response to the increasing demand for breast specialist training, the Society of Surgical Oncology developed an approval process to certify newly formed breast fellowship programs. The majority of breast surgery in the United States is performed by surgeons with general surgery backgrounds, some of whom have undergone the specialized fellowship training in either surgical oncology or breast surgical oncology. Retrospective and small series research efforts have suggested that oncoplastic approaches may improve aesthetic outcomes without compromising oncological outcomes for patients undergoing breast-conserving surgery and may extend the reach of breast conservation to patients who may have otherwise required mastectomy. Development of prospective studies with positive outcomes may increase breast surgical oncologists’ comfort with the oncoplastic approach and further define oncoplastic surgery’s role in the breast surgeon’s practice.