Intramammary lymph nodes (IMLN) are present in up to 47% of breasts and may be involved in metastatic disease in up to 9.8 % of operable breast cancer cases. IMLN are likely to be increasingly recognized with wider acceptance of high quality screening mammography and the use of ultrasound assessment of breast disease. The aim of this study is to demonstrate how IMLN can have an impact on management of breast cancer patients by presenting a case series of three patients. We conclude that IMLN metastases from breast cancer alters the prognosis and hence the management of patients. This will need to be addressed more frequently as sentinel node biopsy is more widely utilized.