Introduction Less than 1% of all breast cancers Risk factors include increased estrogen radiation gynecomastia estrogen therapy klinefelter's (XXY) Nearly 100% are ductal carcinoma Presentation Average age of presentation is 65 Presents with painless breast mass skin changes nipple discharge Evaluation Diagnosed with biopsy and mammograms Managment Treat aggresively because of early involvement of pectoralis major and skin radical mastectomy or modified radical mastectomy