Abstract Objective: This retrospective study evaluates breast MRI-Guided Clip Marker Placement (MRCMP) without concurrent biopsy for preoperative surgical localization where a component of disease extent can only be seen on MRI. Achievement of negative surgical margins was the primary outcome. Material and Methods: 28 patients with 30 lesions underwent breast MRCMP without a concurrent biopsy between May 2008 and February 2019. Age, lesion type (Mass or Non-Mass Enhancement (NME)), size, type of localization, pathology, surgical margins (positive or negative) and post-surgical course were recorded. Results: 23 patients had malignant breast pathology and were included in the study. 12(52%) presented as a mass and 11(48%) as NME. Mean lesion size was 3.6 cm (median 2 cm, range 0.4-13.5 cm). No difference in lesion size or type was identified between the positive and the negative surgical margin groups (p = 0.53 and p = 0.51, respectively). 17(74%) underwent preoperative image-guided surgical localization following MRCMP. Seven (41%) were localized with radioactive seeds, seven (41%) with wire guidance and three (18%) with magnetic seeds. 13(57%) received neoadjuvant chemotherapy. Final pathology for eight (35%) was invasive and in situ ductal carcinoma (DCIS), five (22%) invasive lobular carcinoma, three (13%) pure IDC, three (13%) pure DCIS, one (4%) invasive mammary carcinoma, one (4%) pleomorphic Lobular Carcinoma in Situ (LCIS), one (4%) angiosarcoma, and one (4%) showed no evidence of residual disease. 17(74%) had negative surgical margins and 6(26%) positive margins. All positive margins had underwent BCS at initial surgery. The use of Neoadjuvant Chemotherapy (NAC) before BCS was the only statistically significant factor between positive and negative margins (p = 0.02). Patients achieving negative margins at surgery received NAC at a higher rate (75%) than positive margins (17%). Conclusion: MRCMP without concurrent breast biopsy is a practical technique for achieving negative margins in patients desiring BCS when a component of disease can only be seen on MRI. This technique has demonstrated utility in facilitating successful excision of disease measuring up to 13.5 cm in our patient population. The MRCMP technique should be considered while MRI compatible wireless localization devices remain unavailable for widespread commercial use.