Background Radio‐guided occult lesion localisation using iodine 125 seeds (ROLLIS) is used to localize impalpable breast cancers for breast conserving surgery (BCS). Previous studies have suggested improved efficiency and patient outcomes with ROLLIS compared with hook‐wire localisation (HWL). The aim of this report is to compare the post‐operative complication rates and safety profiles of ROLLIS versus hook‐wire guided surgery. Methods Between September 2013 and March 2018, 690 women with non‐palpable breast cancer eligible for breast‐conserving surgery were randomly assigned to either pre‐operative localisation with 125 I seed or hook‐wire as part of the ROLLIS clinical trial. Medical record review of 170 women (30% of the total participants) from three tertiary hospitals in Western Australia was performed. Post‐operative complications were classified using the Common Terminology Criteria for Adverse Events(CTCAE) grade I to V. Results Total of 170 surgeries were performed: 82 by ROLLIS and 88 by hook‐wire. The overall complication rate in the ROLLIS group was 19.5%, with 15.9% being grade II and 3.66% grade III. In the HWL group, the complication rate was 22.7% with 20.5% being grade II and 2.27% grade III. There was no statistically significant difference in complication grades between the 2 groups. No grade IV or grade V complications were reported. Complications observed included drainable seroma, drainable haematoma and surgical site infection. Conclusion ROLLIS is a safe method of localisation for surgical resection with similar complication rates as hookwires. We encourage its use as an alternative localisation technique as it has demonstrable superiority and efficacy.