Abstract Background: Large-core biopsies or open biopsies with needle localization have been the mainstay of treatment for evaluating nonpalpable mammographic abnormalities. The newly introduced Advanced Breast Biopsy Instrumentation (ABBI) system combines digital stereotactic imaging with a highly developed single-use biopsy device to locate and remove a radiographically discovered breast lesion to an accuracy of 1 mm. Study Design: We conducted a review of the first 58 cases involving the use of the ABBI system. This article evaluates the accuracy of specimen targeting, the success rate of lesion removal, the operative complications, the mechanical difficulties, and patient satisfaction with the ABBI system. Results: The lesion was removed successfully in 47 of the 58 cases. Nine patients were eliminated in initial screening and the procedure could not be completed in two. Although the success rate was high, 14 of the procedures required conversion to “open” ABBI procedures for completion of the biopsy. Conclusions: The ABBI system is an alternative to open biopsy with needle localization or large-core biopsy for nonpalpable mammographic abnormalities. This technique allows complete removal of the lesion in a one-step procedure. The ABBI system has certain limitations and mechanical problems, at least currently, and offers an advantage over current diagnostic modalities in a very limited number of cases only.