Background: Breast cancer is the most common form of cancer worldwide, with a high mortality rate. Romania ranks first in Europe in the incidence and mortality of breast cancer. Content: The presentation highlights the principles of management of breast cancer in advanced pregnancy. The case of a 39-year-old woman, 32 weeks pregnant, taken to the emergency department for painful uterine contractions is also presented. General clinical examination revealed a palpable breast mass in the right breast with perilesional skin erythema and a bloody nipple discharge, raising the suspicion of Paget’s disease of the breast. The breast ultrasound (US) described a hypoechogenic mass between the inferior breast quadrants. The diagnosis of invasive ductal carcinoma was sustained by elastography and established after ultrasound-guided breast biopsy. The caesarean delivery was performed (33-34 weeks) followed by bilateral ovariectomy. Subsequently, after neoadjuvant chemotherapy, the patient underwent Madden modified radical mastectomy and continued with chemotherapy and radiotherapy. Medical imaging provided valuable information for tumor staging and re-staging, guiding the treatment strategy as well as subsequent follow-up. Conclusions: This case underlines the limited treatment options in pregnant women with oncological pathology and highlights the fine line between maternal health and child safety for ensuring the best outcome.