Vacuum-assisted breast biopsy (VABB) is widely used in the excision of benign breast lesions in China. It is also safe, accurate and convenient in the diagnoses of malignant tumors. For management of breast imaging reporting and data system (BI-RADS) 3 lesions, such as flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesion (PL) and radial scar (RS) diagnosed by core-needle biopsy (CNB) or VABB, excision by VABB is recommended in preference to open surgery. Image-guided VABB is a safe diagnostic method for microcalcification and is progressing toward complete resection. Special attention after VABB should be paid to intraductal papilloma patients who are elderly, with residual lesions, atypical hyperplasia and peripheral type. There is still a certain residual tumor rate after VABB in early-stage breast cancer with small tumor focus. Nowadays, it is recommended to further expand the resection of malignant tumors. The era of VABB combined with sentinel lymph node biopsy as local treatment for breast cancer has not come yet; VABB evaluation after neoadjuvant chemotherapy is also in exploration. This article reviews the research progress of VABB in the treatment of suspected malignant breast lesions.