Papillary lesions of the breast include a variety of benign, atypical, and malignant lesions whose hallmark is the formation of either papillary tufts composed only of epithelium, or true papillary structures with fibrovascular support and epithelium. The precise diagnosis has significance because of the variability in treatment modalities. This article attempts to describe the basic features seen in papillary-type lesions and their correlation with imaging studies.