Aim: To review the outcome of vacuum-assisted removal of breast papillomas performed in the Bolton Breast Unit. Materials and methods: Twenty-six benign breast papillomas were excised using an ultrasound-guided, vacuum-assisted technique under local anaesthetic over a 6-year period. An 8 G Mammotome was used for 12 lesions, an 11 G Mammotome for 13 lesions and a 7 G EnCor for one lesion. The mean lesion size was 9 mm (range 3-17 mm). The mean number of cores taken per case was nine. Results: One patient developed a post-procedure haematoma, which did not require treatment. There were no other short-term complications. None of the papillomas were associated with atypia or malignancy. Subsequent breast imaging (mostly routine screening mammography) was reviewed and evidence of recurrence recorded. To date, 16 patients have received at least one subsequent routine screening mammogram, with a mean follow-up to latest mammogram of 30 months. Mammographic evidence of papilloma regrowth has been observed in two patents, with a third patient presenting with recurrence of the original symptom of a palpable lump. All three recurrent lesions were surgically excised and confirmed to be benign papillomas. These lesions measured 6, 12, and 15 mm prior to the original vacuum-assisted excision. Conclusion: The findings suggests that vacuum-assisted removal is a satisfactory alternative to surgery for the majority of patients, but that particular attention should be paid to ensuring complete lesion removal in view of the relatively high recurrence rate in this series. © 2009 The Royal College of Radiologists.