Aim: This pilot study explored the feasibility and preliminary effects of a home-based complex exercise programme compared with Pilates in breast cancer survivors with lymphoedema, delivered and assessed remotely via telemedicine.  Methods: Participants were non-randomly allocated to Pilates or complex exercise based on recruitment order and preference. Remotely supervised assessments of lymphoedema severity, mobility, and quality of life (QoL) were conducted at baseline and after a 10-week individualised exercise programme.  Results: Fourteen participants were included (7 per group), with good adherence and no adverse events. Shoulder range of motion on the affected side increased in both groups (Pilates: +5.3°–11.1°; complex exercise: +6.2°–10.9°). Lower-body mobility findings were mixed: the Pilates group showed consistent within-group improvements in the Chair Sit-and-Reach test (right: +4.5 cm; left: +6.3 cm), whereas between-group effect size estimates tended to favour the complex exercise programme (r = -0.30 to -0.22). On the affected side, limb circumference decreased within the complex exercise group (up to −1.0 cm), with effect size estimates favouring this group (d ≈ 0.6). QoL improved in both groups, with greater improvement in the Health Change domain in the Pilates group, corresponding to a large between-group effect size favouring Pilates (r = -0.62, 95% CI -0.87 to -0.10).  Conclusion: These preliminary findings support the feasibility of remotely delivered Pilates and complex exercise programmes and provide effect size estimates to inform the design of future adequately powered randomized controlled trials.