Abstract Breast elastography is a new sonographic imaging technique for the characterization of focal breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a non-invasive evaluation of the stiffness of a lesion. Two different technical approaches are available for clinical use: free-hand elastography (USE) and shear wave elastography (SWE). Initial results of these techniques in clinical trials suggest that elastography substantially improves the US capability in differentiating benign from malignant breast lesions, thus reducing the number of breast biopsies in benign nodules. This review paper, based on an extensive literature search, highlights the basics of breast elastography, including main technical features, how to do suggestions, limit and pitfalls, and presents the results of major clinical studies.