To explore the effect of plastic breast conserving surgery on postoperative breast aesthetics and prognosis in patients with early-stage breast cancer. Methods Sixty patients with early-stage breast cancer admitted to our hospital from March 2019 to June 2021 were randomly divided into control group and observation group, with 30 patients in each group. The control group was treated with conventional breast conserving surgery, and the observation group was treated with plastic breast conserving surgery. The postoperative breast aesthetics and prognosis of the two groups were compared. Results The excellent and good rate of breast aesthetics in the observation group was 96.67%, which was higher than 73.33% in the control group (P <0.05). There was no recurrence and distant metastasis in the two groups after 1 year of treatment, and the survival rate was 100.00%. And there was no significant difference in the survival rate, recurrence rate and distant metastasis rate between the two groups after 2 years of treatment (P >0.05). Conclusion Plastic breast conserving surgery is effective in patients with early-stage breast cancer, which can improve the postoperative breast aesthetics of patients, and the prognosis is good. Meanwhile, it will not increase the recurrence rate and distant metastasis rate.