Background: Presurgical Magnetic Resonance Imaging (MRI) is increasingly used for staging patients with breast cancer. If breast-conserving surgery (BCS) is required, MRI evaluation has to be carried out to cases with suspected breast cancer, in particular those with dense breast parenchyma, in which the sensitivity of ultrasonography and mammography is low. Objective: The aim of the current study is to evaluate the validity of MRI in surgical decision making in women with dense breast who are provisionally diagnosed to have breast cancer by sono-mammography and are considered suitable for BCS with pathological correlation of MRI findings. Patients and methods: A prospective case series was conducted on females with dense breast admitted at Mansoura Oncology Center, during the period of 2 years. The study included patients with dense breast (mammography ACR C & D) who are provisionally diagnosed to have breast cancer by sono-mammography and are considered suitable for BCS. All cases underwent breast sonography and MRI. Results: The study was carried out on a total of 30 female cases, with mean age 43 years old. All cases show abnormal sono-mammographic findings. MRI displayed additional suspicious findings in the form of non-mass enhancement in 50%, multifocal lesions in 10%, multicentric lesions with non-mass enhancement and deep fascia infiltration in 3.33%. Concordance and discordancy between MRI additional findings and pathology displayed true positive in 95.2%. Only 1 (4.8%) non-mass enhancement was false positive (4.8%). Conclusion: Regarding BCS for cases with dense breast, preoperative breast MRI provides more information in detecting multifocal, multicentric, and extension of lesions which is necessary for determining the management plan.