Objective To explore the effect of progressive health education combined with psychological cognitive nursing on breast aesthetics and psychological state in patients after breast surgery. Methods A total of 80 patients who underwent breast surgery in Houjie Hospital of Dongguan from January 2023 to December 2024 were selected. According to the random number table method, they were divided into the control group and the observation group, with 40 patients in each group. The control group received conventional nursing, and the observation group received progressive health education combined with psychological cognitive nursing on the basis of the control group. The breast aesthetics, psychological state, health behavior and complications were compared between the two groups. Results The scores of symmetry, breast shape and verticality in breast aesthetics in the observation group were lower than those in the control group (P <0.05). After nursing, the scores of SAS and SDS in the two groups were lower than those before nursing, and the scores of SAS and SDS in the observation group after nursing were lower than those in the control group (P <0.05). After nursing, the scores of physical exercise, stress management, interpersonal relationships, nutrition, spiritual growth and health responsibility in the two groups were higher than those before nursing, and the scores of physical exercise, stress management, interpersonal relationships, nutrition, spiritual growth and health responsibility in the observation group after nursing were higher than those in the control group (P <0.05). Compared with the incidence of adverse reactions of 15.00% in the control group, the incidence of adverse reactions in the observation group was lower, only 2.50% (P <0.05). Conclusion Progressive health education combined with psychological cognitive nursing can improve the breast aesthetics in patients after breast surgery, alleviate negative emotions, cultivate a healthy lifestyle, and reduce the incidence of postoperative co mplications, which is worthy of clinical application.