Introduction: Breast cancer management is complex, requiring personalised care from multidisciplinary teams. Management disparities exist between rural and metropolitan areas in treatments and outcomes. This study aims to determine the clinical and non-clinical factors contributing to unwarranted variation in breast cancer management in regional patients. Methods: Comprehensive data from patients who had primary breast cancer surgery from 2010-2014 in either a rural or metropolitan location in a single local health district were analysed (n = 686). Records were subset into two rurality groupings based on the postcode in which the patient resided, and the Modified Monash Model, an Australian system for classifying rurality. Outcomes included treatments received, pathway timeliness, recurrence, and survival. Results: Rural patients had higher mastectomy rates than metropolitan patients (57% vs 34%, p < 0.001), despite a lack of difference in clinical or demographic factors accounting for such variation. Time between treatment pathway stages was consistently longer amongst rural patients (p < 0.01). Rural women also had worse survival outcomes, especially amongst HER2-positive patients who had significantly lower survival (5-year 74% vs 82%; 10-year 49% vs 71%, p < 0.05) than metropolitan HER2-positive patients. Conclusion: This study reveals clinical disparities among rural breast cancer patients, that cannot be explained by demographic and clinical factors alone. Rural patients experience lower rates of breast conserving surgery and delays in treatment milestones, highlighting systemic barriers. The findings have important implications for improving equity and collaboration in delivering person-centered breast cancer care.