In recent years, a multidisciplinary approach for breast cancer patient management has been adopted to provide an accurate evaluation of primary/recurrent tumor and to guiding appropriate treatment. The introduction of positron emission tomography (PET) and PET/computed tomography (CT) with 18F-fluorodeoxyglucose and other radiolabelled molecules for the early detection of breast cancer recurrence has important consequences both for staging and treatment planning. In particular, in the last few years, research efforts have been made to guide targeted or local therapies directing against the cancer outgrowth. Based on the available data in the literature, in the present review, we will discuss 1) the role of PET and PET/CT in guiding local therapies for breast cancer recurrences, (both loco-regional and distant sites); and 2) its current status in clinical practice and its possible future role.