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Abstract Purpose Breast cancer is the most frequently diagnosed cancer in women worldwide. Surgery is a major treatment modality, and over the years, breast-conserving surgeries with breast radiation have shown similar outcomes with mastectomy. Little is known about the frequency and outcome of breast-conserving surgery in Africa. This systematic review provides a comprehensive summary of the evidence evaluating cosmetic and oncologic outcomes after oncoplastic breast-conserving surgery (OBCS) for breast cancer in African women. Methods This review was performed according to the PRISMA statement. Databases were systematically searched for studies on African women undergoing OBCS. The oncologic and cosmetic outcomes, as well as the localization and reconstruction techniques, were evaluated. Descriptive statistics were used to summarize the frequency and proportions of the extracted variables. Results The literature search yielded 266 articles but only 26 of these were included in the review. These studies collectively evaluated 1896 patients with a mean age of 48.2 years and a mean follow-up period of 36.9 months. The most common histopathology was T2 (71.4%) invasive ductal carcinoma. Hook wire localization was the most common technique used for nonpalpable lesions in 85.3% of patients. Of the studies reporting oncoplastic technique, the latissimus dorsi volume replacement technique was the most reported (15%). Seroma was the most common postoperative complication (44.6%). Among studies that reported oncologic outcome data, the crude overall survival and disease-free survival were 93.1 and 89.4%, respectively. Conclusions This systematic review revealed that the outcome of OBCS in African women compares with that in developed countries.