Aim: This study aims to evaluate the correlation between tumor size, surgical margin status, and recurrence rates in patients undergoing breast-conserving surgery (BCS) for breast cancer. Material and Methods: A prospective observational study was conducted on 110 breast cancer patients undergoing BCS. Inclusion criteria included histologically confirmed breast cancer and willingness to participate in a 24-month follow-up. Patients with neoadjuvant chemotherapy or distant metastases were excluded. Data on tumor size, margin status, recurrence rates, tumor grade, hormone receptor status, and adjuvant therapies were collected. Tumor size was measured pathologically, and margin status was categorized as clear (>2 mm), close (≤2 mm), or positive (tumor on ink). Recurrence was defined as biopsy-proven local or regional tumor regrowth. Results: The mean age was 50.72 years, and the mean tumor size was 30.45 mm. Clear margins were achieved in 61.82% of patients, while 28.18% and 10.00% had close and positive margins, respectively. Recurrence occurred in 22.73% of patients and was significantly associated with margin status (p=0.015). Radiation therapy demonstrated the lowest recurrence rate (14.29%), followed by hormonal therapy (17.39%) and chemotherapy (34.29%). Tumor size was a significant predictor of recurrence (coefficient = 0.038, p=0.035). Clear margins were strongly associated with reduced recurrence (p=0.018), and margin status showed a significant correlation with recurrence (r=0.592, p=0.005). Conclusion: Tumor size and margin status are critical predictors of recurrence in BCS. Clear surgical margins and smaller tumor sizes significantly reduce recurrence risks, while adjuvant therapies, particularly radiation and hormonal therapy, further improve outcomes. These findings emphasize the importance of individualized treatment planning, meticulous margin assessment, and effective adjuvant therapy to optimize patient care.