The purpose of this study was to assess the value of magnetic resonance imaging (MRI)-guided intervention in women with a significant hereditary susceptibility to breast cancer due to both family and personal history of breast cancer (heterozygote risk >20%). Thirty women were referred for MR-guided intervention. MR examinations (1.0 T, T1-weighted 3D FLASH, 0.15 mmol Gd-DTPA/kg body weight, prone position) were performed using a system which allows vacuum-assisted breast biopsy or wire localization. Histologic findings in 41 procedures revealed six invasive carcinomas, eight ductal carcinomas in situ and two atypical ductal hyperplasias. Twenty-three benign histologic results were verified by an MR-guided intervention, retrospective correlation of imaging and histology and by subsequent follow-up. In two lesions the indication dropped as the enhancing lesion was no longer visible on the date of planned intervention. Absent enhancement was confirmed by short-term re-imaging of the non-compressed breast and by follow-up.