Breast cancer remains a worldwide big killer also in countries with a long tradition of screening mammography [1]. Multifocal and multicentric nature of breast cancer has been widely demonstrated with a rate of ipsilateral additional cancers on histology up to 60% [2,3]. The annual risk for metachronous contralateral cancer in women with a previous history of breast cancer is 0.4–0.6% [4]. Breast conserving treatment, if compared with mastectomy, does not reduce survival rate even though it implies a higher incidence of ipsilateral recurrence with an annual rate of 0.5–1.0% [5,6]. Moreover, when conserving surgery is used, positive or close margins at final histology require re-excision up to 20–40% of cases. Bilateral contrast-enhanced breast MRI has been demonstrated to outperform mammography and ultrasonography in evaluating index tumor size as well as in detecting additional ipsilateral and contralateral cancers, showing otherwise undetected multifocal/multicentric disease in up to 20% of cases [7] and an incremental detection rate for contralateral cancers of about 4% [8]. In this scenario, preoperative breast MRI has been advocated for improving surgical planning by a reduction in re-excision rate, reducing in-breast cancer recurrences, and providing a screening tool for clinically unaffected contralateral breasts. While MRI has been demonstrated to prompt more extensive surgery in a not negligible proportion of women, its impact on clinical outcomes has not yet been demonstrated. Plana et al. [9] reported a 12.8% correct change (i.e., histologically confirmed) in surgical management versus a 6.3% inappropriate wider surgery (due to false positives MRI findings) while a 3% conversion to bilateral breast surgery (appropriate in 2.6%), confirming previous meta-analyses [7,8]. Thus, we would face a balanced result for the contralateral breast: about 3–4% of MRI-detected contralateral cancers versus 2–3% cumulative rate of expected contralateral cancers in the first 4–5 years. Conversely, we would have a 11–12% of MRI-induced