Although rare – this is only the second case report of bilateral breast metastases from renal carcinoma – it has a strong clinical message that recognising the possibility of metastases can save the patient from more radical surgery. It also reminds us all of the importance of the past medical history. In this case Ganapathi and colleagues describe an elderly lady presenting with bilateral breast lumps who was initially thought to be primary breast carcinoma but who, on investigation, was found to have metastatic breast disease.