Breast papillary lesions are associated with an uncertain malignant potential and traditionally are managed with diagnostic surgical excision. Even for benign lesions without atypia, their pathology can be heterogenous, and range from benign lesions such as intraductal papilloma (IP) to more sinister lesions such as malignant adenomyoepithelioma (MAME). This study aimed to assess the outcomes of patients who underwent diagnostic surgical excision of papillary lesions, including recurrence of benign tumours and incidence of breast cancer. A retrospective analysis of patients who underwent diagnostic breast surgery between 2021 and 2023 was performed. The outcomes of patients whose biopsy was suggestive of a papillary lesion were reviewed. 211 patients had diagnostic excisional surgery during the study period. 107 patients (7%) had IP on final histology. Of these, 16 (15%) were associated with benign lesion recurrence, 11 patients (10%) with further benign papillary lesions. 28 patients with previous IP (2.3%) developed breast malignancy. 1 patient with no prior history of breast disease was diagnosed with MAME. The patient was treated surgically with a mastectomy and sentinel lymph node biopsy. Post-operatively, multidisciplinary discussion recommended adjuvant endocrine and radiotherapy. Our study demonstrates 10% of patients diagnosed with a single benign IP developed further papillomatous disease, 2.3% of patients with breast malignancy had previous diagnosis of IP, and 1 patient was diagnosed with MAME. Multiple case reports of MAME have been diagnosed post re-excision of benign breast tumours. Thus, demonstrating the need to be cognisant when managing patients with papillary lesions, including their screening needs.