Purpose: This study investigates how geographic factors (rural vs. urban residence) influence breast cancer treatment pathways and survival outcomes, particularly in relation to different breast cancer receptor subtypes (luminal A, luminal B, HER2-positive, and triple-negative). Methods: Data from 686 breast cancer patients who had primary surgery between 2010 and 2014 in the Illawarra Shoalhaven Local Health District were analyzed. Patients were grouped by receptor subtype and rurality using the Modified Monash Model. Comparative analyses assessed time to treatment, surgical choices, and survival outcomes using Kaplan-Meier and multivariable Cox regression. Results: Rural patients had longer treatment delays across all subtypes, with HER2-positive rural patients experiencing a median surgery delay of 3.6 weeks vs. 2.7 weeks for urban patients (p < 0.01). Rural patients had higher mastectomy rates, especially in triple-negative cases (67% vs. 50%, p = 0.01). Survival disparities were most notable in aggressive subtypes: rural HER2-positive patients had a 10-year survival rate of 49% vs. 71% in urban patients (p = 0.02), while rural triple-negative patients had poorer 5-year survival (65% vs. 74%, p = 0.04). Poor survival predictors included rurality (HR: 1.6, p = 0.02), delayed systemic therapy (HR: 1.8, p < 0.01), and incomplete trastuzumab regimens (HR: 2.7, p < 0.001). Conclusion: Aggressive breast cancer subtypes, particularly HER2-positive and triple-negative, show worse survival outcomes in rural women due to treatment delays and limited access to specialized care. Addressing these barriers is key to improving survival and achieving equity in outcomes.