Breast conservation therapy (BCT) is one of standard treatments for early breast cancer. Ipsilateral breast tumor recurrence (IBTR) after BCT remains a matter of great concern in clinical practice. Positive surgical margins and lack of radiotherapy or systemic therapy have been confirmed to be high-risk factors for IBTR. Due to the prognosis varying from patient to patient, further risk stratification assessment is still needed. Early prediction and accurate diagnosis of IBTR are important guarantees for improving the prognosis and survival rate of patients. Breast magnetic resonance imaging (MRI) has extremely high soft tissue resolution and spatial resolution, which would be of significant clinical value in preoperative evaluation and postoperative follow-up. This article reviewed the research status and progress of MRI in BCT and IBTR.