Breast cancer surgery is an emotive topic and rather than just simple cosmetic issues, the final appearance of the operated breast has been shown to have a significant impact on psychologic well-being and overall quality of life. Wide local excision (WLE) is a popular conservative approach to small tumors, which do not involve the nipple-areolar complex. This study compares WLE via an anterior and lateral approach. A retrospective survey of patient satisfaction was performed using a recognized and validated Body Image Score (BIS), which was sent to a total of 267 patients who had undergone WLE by either the anterior or lateral approach. The response rate was 57%, of which 89 women had undergone surgery via the anterior and 80 by the lateral approach. There was no significant difference in BIS when comparing the anterior and lateral approaches, despite concerns regarding the physical appearance of the scar and postoperative breast expressed by patients. Generally, surgery on the upper part of the breast was associated with less satisfaction than the lower, but "hiding" the scar with a lateral approach did not improve satisfaction. Surgeons should be reassured that the approach to WLE of early breast cancers has no impact on the patients overall body image and that the choice of technique should be based on the patient's personal preference and the surgeons experience and skill.