We discuss a bent-ray ultrasound tomography algorithm with total-variation (TV) regularization.We have applied this algorithm to 61 in vivo breast datasets collected with our in-house clinical prototype for imaging sound-speed distributions in the breast. Our analysis showed that TV regularization could preserve sharper lesion edges than the classic Tikhonov regularization.Furthermore, the image quality of our TV bent-ray sound-speed tomograms was superior to that of the straight-ray counterparts for all types of breasts within BI-RADS density categories 1-4.For all four breast types from fatty to dense, the improvements for average sharpness (in the unit of (m· s) -1) of lesion edges in our TV bent-ray tomograms are between 2.1 to 3.4 fold compared to the straight ray tomograms. Reconstructed sound-speed tomograms illustrated that our algorithm could successfully image fatty and glandular tissues within the breast. We calculated the mean sound-speed values for fatty tissue and breast parenchyma as 1422 ± 9 ml s (mean± SD) and1487 ± 21 ml s, respectively. Based on 32 lesions in a cohort of 61 patients, we also found that the mean sound-speed for malignant breast lesions (1548±17 mls) was higher, on average, than that of benign ones (1513±27 mls) (one-sided p