Purpose <p>The aim of this prospective cohort study was to compare the identification of complications through telehealth versus face-to-face appointments following breast cancer surgery. Client satisfaction and acceptance of each appointment mode were also examined.</p> Methods <p>Fifty-three participants with a diagnosis of breast cancer were recruited from a breast surgery pre-admission clinic and attended two modes of assessment: video telehealth and face-to-face. The assessments were 2–7&#xa0;days apart, 16–34&#xa0;days post-surgery. Complications related to an increased risk of lymphoedema were assessed by a lymphoedema physiotherapist or occupational therapist as present or not: wound healing and infection, shoulder range of motion, cording, upper limb or breast swelling, and pain. Participants completed an online satisfaction survey after each appointment. Observed agreement and Gwet’s AC1 coefficients were used to examine the agreement in complication identification between assessment modes. An a priori agreement coefficient of ≥ 80% was deemed clinically acceptable.</p> Results <p>Agreement between telehealth and face-to-face appointments met the criteria for acceptability for wound healing, infection, and shoulder range of motion. However, swelling (AC1 coefficient 0.59, 95%CI 0.36–0.82), cording (0.71, 95%CI 0.51–0.90), and pain (0.79, 95%CI 0.63–0.95) did not meet the criteria. Eighty-nine percent (<i>n</i> = 39/44) of participants agreed they would use telehealth again, while 67% (<i>n</i> = 34/51) of participants preferred the face-to-face appointment over the telehealth appointment.</p> Conclusion <p>Agreement levels for identifying swelling, cording, and pain via telehealth were deemed not acceptable. Improved questioning and screening practices are required to improve the detection of complications during telehealth appointments. This will ensure the accessibility of effective post-operative complication screening for all people post breast cancer surgery.</p>