Mammary ductoscopy (MD) allows direct visualization of the mammary ducts using sub-millimetre fiberoptic microendoscopes inserted through the ductal opening onto the nipple surface. MD is a useful diagnostic adjunct in patients with pathological nipple discharge (PND). Furthermore it can reduce the number and extent of duct excision operations for PND. However its potential use in the early detection of breast cancer, guiding breast conserving surgery (BCS) for cancer, therapeutic ablation of intraductal disease, and guiding risk-reducing strategies among high risk women requires further research and evaluation. Future developments include the development of a biopsy kit, combining MD with molecular diagnostic markers and real-time optical biopsy system for the diagnosis of premalignant and early malignant disease and radiofrequency for curative ablation of intraductal lesions.