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Objective This study aimed to examine the rare locally aggressive intermediate tumors and malignant primary breast mesenchymal tumors in patients receiving surgical treatment. Summary of background data Locally aggressive intermediate tumors were subdivided into nonmetastasizing and rarely metastasizing, and the malignant group was subdivided as a single subgroup called able to metastasize. A retrospective examination of surgical notes and clinical charts was carried out reviewing gender, age, symptoms, duration of symptoms, tumor size, clinical presentation, radiation history, kind of surgery undergone, adjuvant radiotherapy, adjuvant chemotherapy, local recurrences, systemic metastases, and mortality. Results Mitotic index and Ki-67 were statistically different between locally aggressive and malignant groups (P < 0.001). One local recurrence occurred in only 1 patient diagnosed as dermatofibrosarcoma protuberans among all patients. None of the entities showed distant metastasis or mortality. In this result, clear margin of surgery in locally aggressive intermediate group and combination of surgery with radiation therapy in the malignant group was the most important determinant for the prospect of the patients with mean follow-up of 28 months. Conclusion The main treatment for localized mesenchymal breast tumors is surgery. When the disease is locally advanced or malignant with high mitotic index, radiotherapy with surgery is predominantly used. Targeted therapies are promising with the limited place of chemotherapy.