Follow-up after breast cancer surgery aims to detect early recurrence, manage treatment side effects and provide psychosocial support. In resource-constrained systems, surgeon-led follow-up clinics may not fully meet all these survivorship issues. Manukau Breast Clinic introduced nurse-led follow-up in 2020 to better address patient needs. There is a paucity of New Zealand data on the effectiveness and utility of nurse-led breast cancer follow-up clinics. This study aims to evaluate the effectiveness of nurse-led clinics from the perspective of patient satisfaction, post-operative complication identification, cancer recurrence detection and cost-effectiveness. Eligible patients who underwent breast cancer surgery and attended surgeon-led clinics (SLC) between 2016-2019 were compared to nurse-led clinics (NLC) from 2020-2023. A 13 ranked-question patient satisfaction survey was sent to all surviving patients. Electronic records were used for data acquisition on patient demographics, complication identification, cancer characteristics and recurrence within 3 years. Cost effectiveness was evaluated as cost-per-patient. SLC had 1234 eligible patients: median age 57; 88 (7.13%) recurrences and 73 (5.92%) complications. NLC had 1469 patients: median age 56; 73 (4.97%) recurrences and 100 (6.82%) complications. SLC detected more recurrences (P= 0.02) but had higher NPI patients (P=0.05). Of the recurrences, SLC had 70.5% detected clinically (as opposed to radiologically) vs 62.2% in NLC (P=0.92). There was no statistically significant difference between complication rates (P =0.39). Total patient satisfaction (TPS) was higher for NLC than SLC (0.13; P=0.14), and was more uniform across ethnicities for NLC. Cost effectiveness analysis revealed NLC was 2.4 times more cost effective than SLC (NZD 425.18 vs NZD 176.22) Compared to SLC, NLC is a more cost-effective follow up service that provides better patient satisfaction across all ethnicities and is non inferior for post operative complication identification and recurrence detection in low NPI patients.