Intramedullary spinal cord metastases are a rare complication of malignancy, associated with a poor prognosis. We describe three cases with extensively pretreated advanced breast cancer developing intramedullary spinal cord metastases two of whom were receiving trastuzumab, one of whom was a male. As therapeutic advances increase overall survival for patients with metastatic breast cancer, patterns of disease are changing with improved systemic control. The incidence of intramedullary spinal cord metastases is likely to increase but management strategies remain unclear.