Background Patients who initially present with a few metastatic lesions from breast cancer are termed as having oligometastatic disease (OMD). The long-term OMD survivors are young patients with a good performance status. Recently, there has been an improvement in systemic and hormonal therapy which could improve patients’ outcome. However, the roles of surgical management of the primary tumor for patients with OMD still need clarifications. Aim The aim was to evaluate treatment effects and patient outcome of surgical excision of the primary tumor in patients with cancer breast, who were initially presented with OMD. Patients and methods This study included 60 patients with breast cancer with OMD. Patients included in our study were divided into three groups, and each group included 20 patients: first, the first group underwent systemic therapy before surgery; second, the second group underwent surgery before systemic therapy; and third, the third group underwent systemic therapy alone. The authors followed all patients for ∼3 years and identified survival rates and patients outcome. Results Young patients underwent surgery more often than old patients after systemic therapy (P=0.006). There is a statistically significant difference between the studied groups regarding recurrence (P=0.038), death (P=0.017), recurrence-free survival (P<0.001), and overall survival (P=0.003). The group that underwent combined surgery and systemic therapy had the most significant longer recurrence-free and overall survival rates. Conclusions Surgical removal of the primary tumor has a curative role in patients with breast cancer with OMD, and it improves patients’ outcome and survival rates