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Uncertainties in the clinical management of breast papillomas is still persisting. The aim of this study is to determine the histological upgrade and malignancy upgrade rate in excisions of breast papillomas detected in breast core needle biopsy. 66 patients who were diagnosed with papilloma by core needle biopsy, followed by surgical excision, without radiology-pathology incompatibility, with complete pathological-radiological data and clinical follow-up were included in the study. Of the benign papillomas (BP), 16.6% (11/66 cases) histologically upgraded to atypical papillomas (AP). There was no upgrade to malignancy. The histopathological diagnosis of the cases diagnosed with BP in the first biopsy after excision was mostly BP again and it was statistically significant, and the upgrade rate was low (p = 0.001). There were two separate statistics showing that as the size of the lesion increases, the rate of histological upgrade increases (lesion size 1 cm, p = 0.008 and lesion size 1.7 cm, p < 0,001). Fragmented (p = 0.004), microcalcified (p = 0.004), Breast Imaging Reporting and Data System (BIRADS) 4B lesions (p = 0.004) the upgrade rate was high (univariate analysis). However, in multivariate logistic regression analysis, a statistically significant correlation was found only between the presence of microcalcification and upgrade (p = 0.031). Although we found a relationship between lesion size, microcalcification, fragmentation, and upgrade to atypia in cases with BIRADS 4B and above, we do not recommend excision because we have no case of upgrade to malignancy. We considered these as risk factors. Therefore, we think that the clinical follow-up of these patients is safe. [ABSTRACT FROM AUTHOR]