Objective: To explore the effect of perioperative refined nursing on patients' overall breast aesthetic score and rehabilitation quality after immediate plastic breast-preserving surgery. Methods: From February 2023 to October 2025, a total of 82 patients who underwent immediate plastic breast-preserving surgery in our hospital were included according to the screening criteria. The patients were randomly assigned to the observation group (41 cases) and the control group (41 cases). The control group received perioperative routine nursing, while the observation group received perioperative refined nursing. The two groups were compared in terms of overall breast aesthetic score, scar condition, self-image, quality of life, and overall satisfaction with nursing three months after surgery. Results: The evaluation results at three months after surgery showed that the observation group performed better than the control group in multiple indicators: higher overall breast aesthetic score, lower scar score and self-image score, higher quality of life and nursing satisfaction. All comparisons between the two groups met the statistical significance criteria (P<0.05). Conclusion: Refined nursing during the perioperative period of immediate plastic breast-preserving surgery can produce multiple positive effects: improved breast aesthetic effect, improved scar condition and self-image, and simultaneous improvement in quality of life and nursing satisfaction.