Aim: This study investigates the role of preoperative imaging and margin assessment in reducing re-excision rates in breast-conserving surgery (BCS) by analyzing the impact of imaging modalities and intraoperative margin evaluation techniques on surgical outcomes. Material and Methods: This retrospective study included 120 female patients with early-stage breast cancer (Stage 0-II) who underwent BCS. Preoperative imaging modalities included mammography, ultrasound, and selectively, MRI. Margin assessment was conducted intraoperatively using frozen section analysis and postoperatively via histopathological evaluation. Data on patient demographics, tumor characteristics, imaging findings, margin status, and re-excision rates were collected. Statistical analysis was performed to identify significant predictors of re-excision. Results: The mean tumor size was 2.10 ± 0.80 cm, with larger tumors (>2 cm) significantly associated with higher re-excision rates (50.00%, p = 0.001). Positive margins were the strongest predictor of re-excision (90.00%, p < 0.001), while intraoperative frozen section analysis significantly reduced positive margins (1.82%, p = 0.019). Ultrasound achieved a higher rate of negative margins (95.83%) compared to mammography (85.00%), while MRI provided the highest negative margin rate (97.50%). Multivariate analysis identified tumor size >2 cm and positive margins as key predictors of re-excision. Conclusion: Preoperative imaging and intraoperative margin assessment are critical in reducing re-excision rates in BCS. Advanced imaging modalities, particularly MRI, combined with frozen section analysis, enhance surgical precision, achieving better oncologic and cosmetic outcomes. A multidisciplinary approach is essential to optimize patient care and minimize repeat surgeries.