Abstract Introduction: Breast-conserving surgery (BCS) combined with radiation therapy is the gold standard for early-stage breast cancer. This study evaluates long-term oncological and cosmetic outcomes in a 16-year cohort at a tertiary care centre in Jaipur, Rajasthan. Materials and Methods: A retrospective analysis was performed on 380 female patients treated between 2003 and 2019. Primary endpoints included overall survival (OS), local recurrence rate (LRR), and cosmetic satisfaction. Survival was calculated using the Kaplan-Meier method. Results: Median follow-up was 104 months. The 10-year OS was 96%, and the LRR at 10 years was 6.0%. Triple-negative breast cancer (TNBC) was significantly associated with distant metastasis (p < 0.05). 80% of patients reported good-to-excellent cosmetic outcomes. Conclusion: BCS remains an oncologically safe and cosmetically superior alternative to mastectomy for Stage I and II breast cancer.