<p>Phyllodes tumor (PT) is a rare fibroepithelial neoplasm of the breast, characterized by a tendency for local recurrence (LR) and distant metastasis (DM). Surgical excision remains the mainstay for management. However, the optimal margin required to minimize LR remains unclear. This study aims to evaluate the rates of LR and DM and assess the impact of histologic grade and margin status on LR. A retrospective cohort study on patients diagnosed with PT [2011–2025]. Data included histologic grade (benign, borderline, malignant), surgical margin status (negative ≥ 1 mm, close &lt; 1 mm, positive; tumor at margin), and type of surgical approach (local excision, wide local excision, mastectomy, re-excision after initial surgery). Statistical analysis was performed using descriptive statistics. A total of 44 patients were included. 59.1% of patients had benign PT (n = 26), 31.8% borderline (n = 14) and 9.1% malignant (n = 4). Surgical approach: 52.3% underwent local excision (n = 23), 29.5% wide local excision (n = 13) and 18.2% mastectomy (n = 8). Final surgical margins were negative in 70.5% (n = 31), close in 4.5% (n = 2) and positive in 25.0% (n = 11). The overall LR rate was 6.8% (n = 3); All cases were borderline PT with negative margins. One (2.3%) developed DM to the lung two years after LR. Tumor biology appeared to be a stronger predictor of LR than margin status. Our cohort has shown that PTs can recur and metastasize despite obtaining negative margins, while no LR was observed in close or positive margins. This suggests that histologic grade and tumor biology rather than margin width may better predict LR, revising the necessity of 1 cm margin. Given the limited number of events, these observations should be interpreted cautiously and considered hypothesis-generating.</p>