Objective To analyze the effect of predictive nursing on postoperative complications and skin aesthetic outcomes in patients undergoing prosthetic breast reconstruction. Methods A total of 98 patients who underwent prosthetic breast reconstruction in the First Affiliated Hospital of Xi'an Jiaotong University from May 2023 to April 2025 were selected as the research subjects, and they were divided into the reference group and the study group by the random number table method, with 49 patients in each group. The reference group was given conventional nursing,and the study group was given predictive nursing. The satisfaction with skin aesthetic outcomes, postoperative complications, quality of life, and coping styles were compared between the two groups. Results Compared with the reference group, the total satisfaction rate with aesthetic skin outcomes in the study group was higher, whereas the incidence of postoperative complications was lower. Moreover, all domain scores of the Functional Assessment of Cancer Therapy-Breast (FACT-B), as well as active-coping score, were higher, and passive-coping score was lower (P <0.05). Conclusion The application of predictive nursing for patients undergoing prosthetic breast reconstruction can improve their satisfaction with skin aesthetic outcomes, reduce postoperative complications, enhance quality of life, and change negative coping styles.