Women who are considered high risk for breast cancer are recommended to undergo supplemental breast cancer screening annually with MRI. There are primarily three safety concerns associated with gadolinium-based contrast agents which include allergic reactions, nephrogenic systemic fibrosis and gadolinium deposition. In this review, we discuss how these risks are affected by molecular structure, will specifically review the difference between the two commonly used agents, gadobutrol and gadoterate, and discuss the most recent FDA approved contrast agent on the market, gadopiclenol.