Objective To analyze the effect of plastic breast conserving surgery in patients with early breast cancer and its influence on breast aesthetics. Methods A total of 72 patients with early breast cancer admitted to the First Hospital of Changsha from August 2021 to August 2023 were selected as the research objects. They were divided into reference group and study group by random number table method, with 36 patients in each group. The reference group was given routine breast conserving surgery, and the study group was given plastic breast conserving surgery. The perioperative indexes, serum tumor markers, breast aesthetics, complications and quality of life were compared between the two groups. Results The operation time of the study group was longer than that of the reference group, the volume ratio of resected tissue to breast was larger than that of the reference group, the intraoperative blood loss and postoperative drainage volume were lower than those of the reference group, the drainage tube removal time and hospitalization days were shorter than those of the reference group (P <0.05). After treatment, the levels of VEGF, TPS and CA125 in the study group were better than those in the reference group (P <0.05). The excellent and good rate of breast aesthetics in the study group was 97.22%, which was higher than 77.78% in the reference group (P <0.05). The incidence of complications in the study group was 2.78%, which was lower than 19.44% in the reference group (P <0.05). After treatment, the scores of psychological field, physiological field, environmental field and mental health in the study group were higher than those in the reference group (P <0.05). Conclusion The effect of plastic breast conserving surgery for patients with early breast cancer is good, which can effectively improve the postoperative breast aesthetics, improve the surgical indicators and serum tumor markers, help to reduce the incidence of complications, speed up postoperative rehabilitation, and promote the quality of life of patients. It is worthy of c linical application.