On the basis of a review of 190 cases of breast cancer in elderly patients, the Authors discuss clinical and anatomopathological features for a proper surgical strategy. After an accurate evaluation of the operative risk and stage of the neoplastic disease, conservative surgical techniques or as less demolitive as possible, i.e. quadrantectomy with axillary lymphadenectomy, Madden or Patey's modified mastectomies, with respect for oncological radicality, are recommended in the elderly. The importance of an early diagnosis in reducing the frequency of locally advanced neoplasms (typical in the elderly) which if operable require Halsted's procedure, is furthermore emphasized.