The purpose of this study is to assess the value of US guided vacuum-assisted breast biopsy compared to surgery for management of intraductal papilloma. This retrospective study included 13 patients with hypoechoic nodular lesion corresponding to small benign intraductal papillomas on biopsy and visible by US. The lesions were removed using US-guided vacuum-assisted biopsy and all tissue material was reviewed at histology. The mean size of papillomas was 9.3 mm (5-16 mm). Vacuum-assisted tumor removal was considered total for all 13 lesions. Maximum follow-up was 57 months. Two patients had tumor recurrence at 22 and 28 months respectively. In one case, atypical ductal hyperplasia was present at the periphery of the papilloma, requiring complementary surgery. US-guided vacuum-assisted excision of small benign tumors such as solitary intraductal papillomas appears to be an alternative to surgical biopsy. Because of the large volume of tissue removed, total tumor excision is possible allowing detection of incidental associated lesions.