Lipoma of the breast often causes diagnostic and therapeutic uncertainty. Clinically it may be difficult to distinguish a lipoma from other conditions. Fine-needle aspiration cytology (FNAC) is often not helpful. Both mammography and ultrasound scanning are often negative. For the present study, 108 women with a clinical diagnosis of lipoma were enrolled prospectively. The clinical diagnosis of lipoma was found to be incorrect in 25.0% of these cases. Mammography and ultrasound revealed a lipoma in only 3.0% and 21.0%, respectively. FNAC revealed only fat cells in 74.0% of cases. In all, only 9 patients (11.4%) fulfilled the triple diagnostic criteria, theoretically making tumour excision mandatory in the remaining cases. Our proposal for management is for any clinical diagnosis of lipoma to be confirmed by either FNAC revealing fat cells or a core biopsy consistent with a lipoma. The mammogram and the ultrasound need not necessarily demonstrate a lipoma, but obviously must not show anything to raise the suspicion of malignancy at the site. If these criteria are met it is not necessary to excise the tumour.