The management of precancerous lesions of the breast has become a considerable clinical problem in the past 20 years, mostly as a consequence of increased detection due to the introduction of mammographic screening. It is not possible to identify with absolute certainty which of these lesions will progress to invasive carcinoma, and tailoring the treatment according to each individual case remains a challenge. There is a particular dilemma for surgeons, who must balance the risk of resecting too much and causing unnecessary cosmetic damage, or resecting too little and leaving an increased risk of recurrence. Further knowledge in the field of predictive and prognostic factors together with the development of gene-profiling techniques will, hopefully, provide answers to these questions. Among precancerous lesions of the breast, particular attention should be paid to ductal carcinoma in situ or intraductal carcinoma, appropriate treatment of which is crucial to prevent invasive breast cancer. Nearly all possible combinations of surgery, radiotherapy and medical treatments (anti-estrogens) have been tested in different clinical trials, but the situation is far from satisfactory. We believe that an important contribution can come from oncoplastic surgery, which is the application of plastic and reconstructive surgical techniques to ensure both radical excision of the disease and acceptable cosmetic outcomes.