Though it has its drawbacks, wire-guided localisation (WGL) is the gold standard for the removal of impalpable breast cancers. The past decade has seen a significant global shift away from WGL to newer techniques (such as markers that utilise radioactive, magnetic, paramagnetic, radar, or radio wave principles) to address device concerns such as theatre scheduling, patient experience, and accuracy. However, adopting a new localisation device too soon without an established evidence base poses potential harm to patients, and traditional research methods may be too slow to disseminate concerns over safety and efficacy. On the other hand, not adopting a new technique can also lead to patients missing out on the benefits of modern techniques. One way to address some of the weaknesses of traditional research and investigate new surgical innovations is the IDEAL framework. Combining this with shared learning can also enable device surveillance for unexpected harms, and aid safe and rapid adoption of newer devices. Existing audits and ongoing trials are incorporating these principles with good effect, already providing high-quality large-scale evidence on a national and international level. One area that still lacks high quality research is the patient perspective. While modern technologies improve patient journeys and logistics, these devices do not provide a three-dimensional view of the lesion within the breast. Emerging technologies however aim to go one step further and provide such a perspective for surgeons.