To identify predictors of hemorrhagic complications after image-guided breast biopsy and evaluate how risk anticipation may improve patient counseling and peri-procedural management.

We retrospectively reviewed consecutive image-guided breast biopsies performed at our institution. Patient characteristics, use of antithrombotic therapy, lesion features, needle gauge, and technical variables were collected.

Bleeding events were graded according to clinical relevance. Our observations were analyzed in parallel with contemporary literature addressing mechanisms, magnitude of risk, and mitigation strategies.

- Most bleeding events in our cohort were minor and resolved with conservative measures. This aligns with recent large reviews demonstrating that clinically significant hemorrhage is uncommon, occurring in less than 1% of procedures.

- While patients receiving antithrombotic therapy often raise concern, emerging evidence indicates that continuation of these medications does not necessarily translate into higher rates of major bleeding.

- Additional factors potentially influencing risk include advanced age, use of larger needle calibers, and increased sampling.

- Despite these associations, most complications remain manageable with appropriate compression and surveillance.

- Together, these data suggest that anxiety surrounding hemorrhage may exceed the true clinical threat.

Bleeding after breast biopsy is usually minor, predictable, and controllable. Integrating risk factors into pre-procedural evaluation allows radiologists to provide more accurate reassurance while maintaining access to essential diagnostic procedures.

1. Clinically significant bleeding after breast biopsy is rare (<1%).
2. Continuation of antithrombotic therapy is often safe.
3. Structured anticipation enables better reassurance and safer care.