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Benign lesions represent the most frequent lesions of the breast. Such lesions often onset with nodules or palpable masses simulating a breast cancer. In uncertain cases, an excisional biopsy may be at the same time a diagnostic and a therapeutic solution. A high percentage (40%) of the diagnosed lesions belongs to fibrocystic disease. A remaining 50% can be shared among tumor-like lesions, inflammatory lesions or benign tumors like fibroadenomas. Only in the 10% of palpable breast masses, biopsy reveals a breast cancer. The role of the pathologist is strictly related to the surgeon's one. Clinically benign lesions may be excised throughout a biopsy performed under local anesthesia. Clinically uncertain lesion must be evaluated by a fine needle aspiration biopsy (FNAB), nevertheless in some cases the doubt may persist. In such cases an excisional biopsy performed while the patient is under general anesthesia may finally solve the question. In case of breast malignancies the intervention can be enlarged as described for cancer.