Purpose of Review <p>Papillary lesions of the breast are rare and comprise a broad spectrum of pathologies from benign to malignant. We review the current data and management of these lesions.</p> Recent Findings <p>Intraductal papillomas are the most common benign papillary lesion and historically were excised due to concern for “upgrade” to malignancy. Recent data shows upgrade rates to be low in lesions that are not associated with atypia on needle biopsy and surgical excision is considered optional when atypia is absent. Papillary malignancies come in a variety of pathologies, but are considered more indolent than other breast malignancies. Management is similar to other breast malignancies, but de-escalation strategies can be considered depending on the clinical situation.</p> Summary <p>Papillary breast lesions are generally benign, but even when malignant are relatively indolent compared to other breast malignancies. Management depends on the clinical situation, but de-escalation can often be considered.</p>