This article reports on the experience of two private practice breast centers in New York and California. It demonstrates that comprehensive breast centers directed by full-time breast imagers have a significant impact on medical care from the perspective of the patient, her physicians, and the health care system. These two centers, separated by a continent, disparate in their formation and founding philosophies, yield very similar results in breast cancer diagnosis, reduction of the benign biopsies, and improving the cost of breast biopsies.