Vascular lesions represent a minority of tumors originating in the breast. The most common entities are benign and include hemangiomas and angiolipomas. Malignant vascular lesions (angiosarcomas) are rare and may be primary or secondary to radiation. Also appreciated in association to radiotherapy is the development of cutaneous atypical vascular lesion affecting the skin of the breast. The relationship of the latter to radiation-associated angiosarcoma is controversial and remains to be elucidated. This article reviews the most likely encountered vascular lesions in the breast, with emphasis on key pathologic diagnostic features and potential diagnostic pitfalls.