Breast cancer is the most commonly diagnosed cancer among women. Nearly 30% of patients diagnosed with early stage breast cancer will develop metastatic disease, with the bone, liver, lung and brain being most common sites. Those distant organs are both of great clinical and biological importance and closely related to the patients survival outcome. Metastatic diseases resistant to adjuvant therapies are responsible for approximately 90% of deaths.The development of metastases depends mainly on tumor size, histologic grade, lymphovascular spread, nodal involvement, and receptor status. It is generally accepted that breast cancer spread is not a matter of chance, but a highly selective, nonrandom process, which is in accordance with the seed and soil hypothesis proposed by Paget in 1889.Clinicopathologic features, molecular subtypes, and the patterns of distant recurrence are of prognostic significance and predictive value in patients with breast cancer. Metastases to the skeleton are the first site of relapse for about 50% of patients and thus among the most commonly observed sites for distant metastases. Bone metastases occur more frequently in patients with ER positive and PR positive tumors, while patients with HER2 positive or TNBC have a predilection for visceral metastases, including to the brain.Further exploring targeted therapies is a critical step towards personalized medicine.