Background: Breast cancer represents the predominant cancer type among females in developed as well as developing nations. Guidelines recommend breast cancers screening utilizing both mammography as well as ultrasonography (US). Objectives: This work was aimed at assessing the diagnostic accuracy of elastography performed with strain elastography (SE) as well as shear wave elastography (SWE) while differentiating between benign as well as malignant breast lesions. Patients and Methods:  Our retrospective study was involved 100 female cases presented with breast masses. All participants underwent a conventional B-mode US exam then assessed based on the BIRADS categories. Additionally, a real time free hand US elastography was carried out during the same session then images were analyzed utilizing the Tsukuba elasticity score as well as the strain ratio method. Results: Out of 100 patients, 44 (44%) patients showed benign, and 56 (56%) patients showed malignant breast lesions. PPV 96.2% for strain ratio, 92.6% for elastoscoring and 88.9% for ultrasound. NPV was 87.5% for strain ratio, 86.9% for elasto scoring and 82.6% for ultrasound. Strain ratio and elasto scoring had the same sensitivity, 89.3% while ultrasound proved to be less sensitivity 85.7%. Strain ratio had the highest specificity 95.5%, followed by elasto scoring was 90.9% and the least ultrasound was 86.4%. The strain ratio was the highest at 92% followed by elasto scoring (90%). The least was ultrasound (86%). Conclusion: Elastography represents a simple approach that possesses superior diagnostic performance. It could be simply utilized along with B-mode ultrasonography during the same session, thus enhances its specificity. It has shown efficacy in reducing needless biopsies, particularly in BIRADS III as well as IVa lesions' evaluation.