This study aims to assess the outcomes and prognostic/predictive factors of overall survival and local control in patients with a diagnosis of brain metastasis from a breast cancer primary who underwent Gamma Knife radiosurgery (GKRS) as part of intracranial treatment. A total of 69 patients were identified who were treated with GKRS for one to four brain metastases from breast cancer as a primary diagnosis. A total of 176 metastases were treated at diagnosis or as salvage treatment. Differences in overall survival time (OS) and local control time (LC) after GKRS between groups were assessed. The median follow-up was 9.2 months (range 3–90.5 months). The median OS for this cohort was 13.4 months (range 0.5–90.5 months). The median LC was 15.8 months. For a given metastasis, univariate analysis showed that LC was significantly correlated with the dose density (DD, ratio of GKRS dose to metastasis volume, [gray per cubic centimeters]). Additionally, human epidermal growth factor receptor 2 (HER2) enrichment predicted for worse local control on univariate analysis [HR 2.18; 95 % CI 1.047–4.532] (p = 0.037). With DD as a continuous variable, the only independent and significant predictive factors were the DD [HR: 0.99; 95%CI: 0.984–0.998] (p = 0.009) and HER2-enriched subtype [HR = 2.25; 95 % CI = 1.074–4.728] (p = 0.032) after accounting for dose, metastasis volume, whole-brain radiotherapy (WBRT), and other subtypes. DD was then examined as a binary categorical variable whether or not a metastasis was treated to, at least, the median DD delivered across the cohort. With the cutoff set at this median, a DD value of 36 Gy/c3, the independent and significant predictive factor again was the DD [HR: 3.49; 95%CI: 1.45–8.40] (p = 0.005) in favor of metastases receiving at least 36 Gy/c3. Additionally, HER2 enrichment was significant when DD was examined as a binary variable, predicting for worse LC [HR 2.20; 95 % CI: 1.048–4.636] (p = 0.037). The median LC for metastasis receiving <36 Gy/c3 is 18.7 months vs. median not reached in those receiving at least 36 Gy/c3 (p < 0.001). For HER2-enriched metastases, a DD ≥36 Gy/c3 resulted in a 14 % failure rate (10-month actuarial), compared to that of 0 % observed in non-HER2-enriched subtypes. The ratio of dose delivered with GKRS to metastasis volume was significantly correlated with LC, with values ≥36 Gy/c3 improving LC. This effect was significantly diminished in HER2 subtypes, and a required higher DD for improved control, suggesting these metastases may be intrinsically resistant to radiosurgery.