Objective To explore the effect of endoscopic breast-conserving surgery combined with stage Ⅰ reconstruction on breast aesthetics in patients with early breast cancer. Methods A total of 96 patients with early breast cancer admitted to Jinan Hospital of Integrated Traditional Chinese and Western Medicine from July 2022 to July 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 48 patients in each group. The control group underwent traditional open breast-conserving surgery, and the observation group underwent endoscopic breast-conserving surgery combined with stage Ⅰ reconstruction. The breast aesthetics, breast volume symmetry, surgical related indicators, complication rate and tumor control effect were compared between the two groups. Results The Harvard excellent and good rate of the observation group (93.75%) was higher than that of the control group (77.08%) (P<0.05). The breast volume symmetry of the observation group was higher than that of the control group (P<0.05). The operation time of the observation group was longer than that of the control group, but intraoperative blood loss, postoperative drainage volume, and drainage tube indwelling time of the observation group were better than those of the control group (P<0.05). The incidence of complications in the observation group (6.25%) was lower than that in the control group (22.92%) (P<0.05). There were no statistically significant differences in negative margin rate, 1-year postoperative recurrence rate and residual gland volume between the two groups (P >0.05). Conclusion Endoscopic breast-conserving surgery combined with stage Ⅰ reconstruction can improve breast aesthetics and breast volume symmetry in patients with early breast cancer, help to reduce postoperative complications, and does not affect the tumor control effect, with definite clinical application value.