Breast biopsy and lesion localization were performed with gadolinium-enhanced magnetic resonance (MR) imaging guidance, with use of a stereotaxic biopsy system consisting of a flexible circular surface coil with an acrylic cylinder as an add-on guidance device. Twenty-five procedures (23 localizations, two core biopsies) were performed in lesions depicted at diagnostic MR imaging, without technical failure. The guidance system permitted easy, precise, and flexible biopsy and localization of all breast lesions.