Objective To analyze the effect of peer support education combined with preemptive goodwill-led empathy nursing on self-efffcacy and breast aesthetic effect in patients undergoing oncoplastic breast-conserving surgery for breast cancer. Methods A total of 80 patients who received oncoplastic breast-conserving surgery for breast cancer in the Department of Thyroid and Breast Surgery, Hejian Hospital of Traditional Chinese Medicine from February 2023 to February 2025 were selected as the study subjects, and they were divided into the control group and the observation group by the random number table method, with 40 patients in each group. The control group was given conventional nursing, and the observation group was given peer support education combined with preemptive goodwill-led empathy nursing on the basis of the control group. The breast aesthetic effect, self-efffcacy and stigma were compared between the two groups. Results After nursing, the scores of horizontal displacement of breast, vertical displacement of nipple, breast symmetry, breast depression and hyperplastic scar in the observation group were higher than those in the control group (P<0.05). After nursing, the scores of positive attitude, self-determination and stress relief in the observation group were higher than those in the control group (P<0.05). The stigma score of the observation group was lower than that of the control group (P<0.05). Conclusion Peer support education combined with preemptive goodwill-led empathy nursing can improve breast aesthetics, reduce stigma and enhance self-efffcacy of patients undergoing oncoplastic breast-conserving surgery for breast cancer.