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The role of the adipocyte in the tumor microenvironment has received significant attention as a critical mediator of the obesity-cancer relationship. Thirteen cancers are considered obesity-associated, including breast cancer, and current estimates indicate that 650 million adults have obesity. Even in people with a normal body mass index (BMI), adipocytes are key players in breast cancer progression due to the proximity of tumors to mammary adipose tissue. Outside of the breast microenvironment, adipocytes influence metabolic and immune function, and produce numerous signaling molecules, all of which impact breast cancer development and progression. Here, we present the current epidemiologic data linking obesity, and importantly adipose tissue, to breast cancer risk and prognosis, focusing on metabolic health, weight gain, and adipose distribution as underlying drivers of obesity-associated breast cancer. We also highlight bioactive factors produced by adipocytes, both normal and cancer-associated, such as cytokines, growth factors, and metabolites, and the potential mechanisms through which adipocytes influence different breast cancer subtypes.