Objective To compare the effects of costal cartilage support and ffap breast reconstruction on aesthetic effect of nipple reconstruction appearance and nipple morphology maintenance rate. Methods A total of 64 patients who underwent nipple-areola reconstruction at Peking University Shenzhen Hospital from October 2024 to October 2025 were selected, and they were divided into the control group and the observation group by the random number table method, with 32 patients in each group. The control group received costal cartilage support breast reconstruction, and the observation group received ffap breast reconstruction. The aesthetic effect of nipple reconstruction appearance, clinical surgical indicators, nipple morphology maintenance rate and complication rate were compared between the two groups. Results The excellent and good rate of nipple reconstruction appearance in the observation group (93.75%) was higher than that in the control group (81.25%) (P<0.05). The VAS score, intraoperative blood loss and operation time in the observation group were better than those in the control group (P<0.05). The nipple protrusion maintenance rate in the observation group was higher than that in the control group, and the width maintenance rate in the observation group was lower than that in the control group (P<0.05). The incidence of complications in the observation group (6.25%) was lower than that in the control group (15.62%) (P<0.05). Conclusion Compared with costal cartilage support breast reconstruction, ffap breast reconstruction has better effects in improving the aesthetic effect of nipple reconstruction appearance and reducing the incidence of complications, and can further optimize clinical surgical indicators and nipple protrusion maintenance rate. However, it is slightly inferior to costal cartilage support reconstruction in terms of width maintenance rate. Therefore, there is no absolute advantage or disadvantage between the two nipple-areola reconstruction methods. A comprehensive decision should be made combined with patients' aesthetic needs and local tissue conditions to select the most scientiffc and optimal treatment method.