The goal of this review is twofold; to highlight the difficulties in identifying, diagnosing, and treating desmoid-type fibromatosis (DF) of the breast and to discuss the current understanding of the key genetic mutations in the disease process that lead to specific treatment regimens. Currently, there are three groups of DF as classified by the World Health Organization (WHO): abdominal wall, extra-abdominal, and intrabdominal. They all present unique diagnostic challenges; however, the gold standard for diagnosis remains histopathologic confirmation even with the increased availability and sensitivity of imaging modalities. Given the importance of genetic alteration in this disease, the following three genes will be discussed: Catenin Beta 1, Rad51, and Poly Adenosine Diphosphate Ribose Polymerase-1. There is mounting evidence that these could potentially be targets for therapy in addition to surgery alone. Historically, diagnosis and treatment of DF of the breast have been difficult, which leads to a need for an interdisciplinary team approach composed of surgeons, pathologists, radiologists, oncologists, and internists which leads to the best overall care for patients with this pathology.