Breast MRI is becoming an important tool for the improved management of breast cancer. The technical attributes of high contrast, high-resolution breast MRI acquisitions are summarized. The fundamentals of image interpretation are outlined, including lesion enhancement, morphological features, and extent categories. The indications for breast MRI include compromised mammography, staging of disease within the breast and adjacent structures, difficult histology, and other special diagnostic situations. Patients with compromised mammography include previous surgery, radiographically dense breasts, and silicone augmentation. The improved determination of disease extent aids in the management of breast conservation treatment. Certain lesions, particularly lobular carcinoma and ductal carcinoma in situ, can be better managed with the information available with breast MRI. Other potential indications are also discussed, including patients presenting with positive axillary nodes and no known primary, women with a high risk of malignancy, and recently postoperative breasts with positive margins. The need for MRI stereotaxis is reviewed, with indications and potential solutions. The potential future roles for MRI-directed interstitial hyperthermia are outlined.