Inclusion Criteria:

• * • BMI 30-45 kg/m2
• * Female
• * Insurance approved or likely approved for tirzepatide clinical use \*
• * Additional risk factors for breast cancer other than obesity (any one or more) First or second degree with breast cancer Known high density on mammogram (heterogenous or extremely dense) Prior biopsy showing atypical hyperplasia or LCIS Prior treated DCIS Known carrier breast cancer predisposition gene mutation or known mutation in family member .
• 2- fold or higher estimated 10 year or lifetime risk compared to population by standard risk model (BCRAT, BCSC, IBIS

Exclusion Criteria:

• * • Subglandular breast implants (women with subpectoral implants are eligible if C cup or greater; breast can easily be pulled off the chest wall; and with approval of PI)
• * Clinical contra-indication to incretin mimetics
• * Insurance/third party has denied coverage and participant does not wish to do self-pay.
• * Child-bearing potential and not on contraceptives
• * Prior invasive breast cancer
• * Currently taking any of the following medications: insulin, tamoxifen, raloxifene, letrozole, arimidex, exemestane, incretin mimetics.