The widespread use of breast imaging has resulted in the increased detection of clinically occult suspicious breast lesions. Between 1999 and 2004 the number of breast biopsies in the United States has increased steadily. The armamentarium of methods to biopsy suspicious breast lesions has also increased significantly since the early 1990s with technological advancements for both surgical breast biopsy and percutaneous image guided breast biopsies. J. Surg. Oncol. 2011; 103:299–305. © 2011 Wiley-Liss, Inc.