A 50-year-old woman with long standing type 1 diabetes mellitus complicated by diabetic retinopathy, peripheral vascular disease and end stage renal disease on hemodialysis was referred for screening mammography by her primary care physician. Her Hb1ac was 7.1% and she was on long acting insulin along with mealtime coverage. Mammography revealed heterogeneously dense breast tissue (Fig. 1 A, B). As a protocol for dense breast, ultrasonography of the bilateral breast was done which showed a large (5.3 × 1.9 × 2.0 cm) irregular hypoechoic mass with posterior acoustic shadowing and prominent peripheral vascularity in the right breast at the 12:00 position (Fig.