The purpose of this study was to evaluate the technical feasibility of MR-guided percutaneous breast biopsy (LCNB) and breast hook wire marking in a low-field (0.23 T) MRI system with optical instrument tracking. MR-guided core biopsy and/or hook wire marking was performed on 13 lesions observable at MR imaging only. Seven breast LCNBs and 10 hook wire markings were performed under MR guidance on 11 patients. The diagnosis was confirmed by excision biopsy or mastectomy in 12 lesions and with histopathological and cytological diagnosis and 12-month clinical follow-up in one lesion. All lesions seen in the high-field scanner were also successfully identified and targeted in the low-field scanner. The following procedures were typically technically successful. There were difficulties due to unsatisfactory functioning of some core biopsy guns. Detailed description of low-field MR guidance and optical tracking in breast biopsies is provided. The procedure seems accurate and safe and provides means to obtain a histological diagnosis of a breast lesion only seen with MRI. The low-field biopsy system is comparable to the high-field MRI system. MR-compatible biopsy guns need to be improved.