The integration of imaging and thermal therapy can provide a minimally invasive or even noninvasive alternative to breast surgery for small tumors. Ongoing trials seek to show safety and efficacy for laser, radiofrequency, microwave, cryoablation, and focused ultrasound surgery. To be successful, these therapies must achieve equivalent or even greater efficacy as surgical outcomes and must demonstrate total ablation of the dominant lesion with negative margins, while sparing normal tissue beyond the target tissue. Procedures have been validated by histopathology subsequent to resection.