Objective To explore the effect of intervention guidance based on nursing aesthetics on breast aesthetics in patients undergoing breast cancer surgery. Methods A total of 72 patients undergoing breast cancer surgery admitted to the Department of Breast Surgery, Hunan Provincial Maternal and Child Health Care Hospital from May 2023 to May 2025 were selected as the research subjects, and they were divided into the control group and the observation group by the random number table method, with 36 patients in each group. The control group received basic nursing intervention, and the observation group received intervention guidance based on nursing aesthetics. The negative emotions, psychological resilience, complication rate and breast aesthetics were compared between the two groups. Results After nursing, the negative emotion scores of the observation group were lower than those of the control group (P <0.05). After nursing, the psychological resilience scores of the observation group were higher than those of the control group (P <0.05). The incidence of complications in the observation group (2.78%) was lower than that in the control group (19.44%) (P <0.05). After nursing, the breast aesthetics score of the observation group was better than that of the control group (P <0.05). Conclusion The application of intervention guidance based on nursing aesthetics for patients undergoing breast cancer surgery can effectively alleviate their negative emotions, enhance psychological resilience, improve postoperative breast aesthetics, and reduce the risk of complications.