Background and purpose <p>Whether serum lipids have an impact on breast cancer(BC) prognosis remains controversial and unstudied. We conducted this systematic review (SR) and meta-analysis (MA) to explore the impact of levels of various components of the lipid profile on multiple survival outcomes (OSs) of BC.</p> Methods <p>We searched Pubmed, Embase, Cochrane Library, and Web of Science for relevant cohort studies to assess the impact of multiple lipids on the prognosis of BC patients. Included studies were subjected to quality assessment using the Newcastle–Ottawa scale (NOS). MA of extracted data was performed using StataSE 15.1.</p> Results <p>17 studies in total were included, involving a sample size of 24,026. MA showed that high levels of low-density lipoprotein cholesterol (LDL-C ) (HR (hazard ratios) = 1.96, 95% confidence interva (CI): 1.03–3.73), apolipoprotein E (ApoE) (HR = 3.68, 95% CI: 1.71–7.94), and apolipoprotein B (ApoB) (HR = 1.93, 95% CI: 1.44–2.59) were associated with poorer OS, while high levels of low-density lipoprotein (LDL) (HR = 0.81, 95% CI. 0.74–0.88) and apolipoprotein D (ApoD) (HR = 0.44, 95% CI: 0.24–0.81) were associated with better OS. Both a high level of total cholesterol (TC) (HR = 1.60, 95% CI:1.08–2.37) and dyslipidemia (HR = 1.71, 95% CI:1.12–2.62) had a negative impact on disease-free survival (DFS) in BC patients.</p> Conclusion <p>This MA showed that the levels of LDL-C, ApoE, and ApoB in serum were associated with OS, and the TC level in serum and dyslipidemia were associated with DFS. However, the levels of blood lipids were less associated with other prognostic outcomes. Other high-quality studies are needed to further elucidate this issue.</p> Registration <p>PROSPERO CRD42024541755.</p>