The cost-effectiveness of localization techniques for breast and axillary lesions is strongly influenced by national healthcare reimbursement systems, making direct international comparisons challenging. Conventional wire-guided localization (WGL) remains widely used due to its simplicity and low acquisition costs. However, WGL presents logistical drawbacks, including time-sensitive placement and interdepartmental coordination, leading to workflow inefficiencies and increased personnel costs. In contrast, modern probe-guided localization (PGL) techniques, such as radioactive and non-radioactive seeds, offer logistical advantages, improved clinical workflows, and increased patient comfort. Though associated with higher initial equipment and material costs, these methods can result in overall cost savings due to reductions in intraoperative delays and resource consumption. In the axilla, sentinel lymph node (SLN) biopsy is standard for staging, with various detection methods including technetium-99 m, blue dye, indocyanine green (ICG), and superparamagnetic tracers. Each technique varies in cost structure, equipment needs, and logistical complexity. Targeted axillary dissection (TAD), increasingly used after neoadjuvant chemotherapy, benefits from precise localization technologies, with seeds providing high detection rates and procedural efficiencies. This chapter adopts a direct costing approach to analyse material and personnel costs, highlighting that WGL may appear cost-effective in acquisition, but modern techniques can yield better economic outcomes when workflow and resource optimization are considered. Additionally, ecological impacts such as carbon footprint favour newer technologies. Given heterogeneous international reimbursement systems, cost-effectiveness evaluations must be context-specific. Overall, advanced localization technologies may offer superior clinical and economic value in appropriate healthcare settings.