Background <p>Treatment for locally advanced breast cancer often involves the use of neoadjuvant chemotherapy (NACT). Conservative surgery for the breast and axilla may be more challenging following NACT because some lesions may become invisible on preoperative imaging. This study aimed to compare surgical clips and US-visualized tissue markers for ultrasound tumor localization in breast cancer patients undergoing neoadjuvant chemotherapy.</p> Methods <p>This was a comparative cross-sectional study conducted on 34 breast cancer patients prepared for NACT. In this study, prior to chemotherapy, 34 clips were used, of which 17 surgical clips were inserted in 17 lesions and another 17 US visible tissue markers were inserted in another 17 lesions; both types were inserted under US guidance. After NACT cycles, the clipped masses were compared by US.</p> Results <p>Approximately 76.5% of patients had a negative family history, and 23.5% had a positive family history. The most common hormonal profile was ER and PR positive, HER2 negative (35.3%), followed by triple negative (32.4%) and ER positive, PR and HER2 negative (14.7%). Ductal carcinoma was found in 91.2% of cases, and lobular carcinoma in 8.8%. Lumpectomy was performed in 88.2% of cases, with mastectomy in 11.8%. No significant differences were found in clip visualization between surgical clips and tissue markers (58.8% vs. 64.7%, <i>P</i> = 0.17) or in pain incidence (35.3% vs. 23.5%, <i>P</i> = 0.71). Complications, including infection, hematoma, and migration, were similar in both groups (<i>P</i> &gt; 0.05). After NACT, no significant differences in clip visualization or radiological response were observed between the two groups.</p> Conclusions <p>Visualizations of both surgical clips and ultrasound-visible tissue markers on US before and after neoadjuvant chemotherapy were nearly equivalent, regardless of lesion prognosis or complete radiological response. No significant differences were observed between the two groups regarding complications.</p>