Breast pathology may be found during preoperative mammagraphy prior to reduction mammaplasty. When nonpalpable lesions are found, a decision must be made: to proceed with the reduction or to biopsy the lesions prior to the reduction. We describe a patient with bilateral breast lesions who underwent bilateral needle-localized biopsies during reduction mammaplasty. Good communication between the radiologist and surgeon is essential for success. The suspicious lesion must be divided from the remaining breast specimen for adequate specimen mammagraphy. The advantage is that both procedures can be done during one anesthetic dose.