PURPOSE: Paget's disease of the breast (PDB) occurs in approximately 1~3% of all primary breast carcinomas. This study aimed to determine the optimal surgical treatments for PDB in this study. METHODS: The medical records of 16 patients with PDB who had been treated between January 1986 and December 1998 were clinically reviewed retrospectively. RESULTS: 13 patients had nipple changes consistent with clinical Paget' disease (CPD) including 8 who had an associated breast mass, and 5 who had no associated mass. Of the 13 patients with CPD, 12 were treated with a modified radical mastectomy while 1 was treated with a radical mastectomy. Breast cancer (BC) was found in all of 13 patients (100%) with CPD. The BC was centrally located in 46% of patients including 38% in CPD associated with the mass and 60% in CPD not associated with the mass. Out of 8 CPD patients associated with the mass, 7 (88%) had invasive cancer, 1 (12%) had a ductal carcinoma in situ (DCIS), and 2 (25%) had pathologic axillary nodes (PAN). The 5 year survival rate was 87.5%. Of the 5 CPD patients not associated with the mass, 4 (80%) had an invasive cancer, 1 (20%) had a DCIS and none had PAN. Their 5 year survival rate is 100%. CONCLUSION: All the patients with CPD had an associated BC. BC is more frequently centrally located in the CPD not associated with the mass (60%) than those associated with the mass (38%). Contrarily, the BC in CPD that was not associated with the mass was located more peripherally (40%). Therefore, the treatment of patients with CPD must be individualized in order to avoid under or overtreatment.