Background and Aims The age of onset of breast cancer in Chinses women is relatively young, so breast-conserving surgery and breast reconstruction following mastectomy are reasonable options to correct breast volume loss in breast cancer patients. With the promotion of breast oncoplastic surgery in recent years, a satisfactory breast shape can be maintained in patients with small-sized breasts after breast-conserving surgery. The breast reconstruction technique using prosthesis combined with a titanium mesh (TiLoop Bra) is relatively simple and easy to popularize, and can also effectively restore the breast shape after total mastectomy. This study was performed to evaluate the pros and cons of the two approaches in terms of surgical efficacy and meeting the functional and cosmetic requirements of patients, so as to provide information for clinical decision-making.Methods The clinical data of patients with early breast cancer undergoing above two procedures from January 2019 to October 2021 in Department of Breast Surgery, Xiangya Hospital, Central South University were retrospectively analyzed. Of the patients, 40 cases each underwent oncoplastic breast-conserving surgery (breast-conserving group) and nipple-areola-complex sparing mastectomy with one-stage reconstruction using prosthesis and mesh (breast reconstruction group). The basic clinicopathologic information of the patients, duration of operative time and drainage after operation, length of postoperative hospital stay, hospitalization cost and the related complications were collected. The outcomes of breast surgery and and patients' satisfaction with their breasts were assessed using the Breast-Q questionnaire.Results Breast-conserving group was significantly superior to breast reconstruction group in terms of operative time, postoperative drainage time, and postoperative hospitalization time and cost (all P<0.001). The incidence rate of nipple numbness in breast reconstruction group was significantly higher than that in breast-conserving group (P<0.001); skin flap necrosis occurred in 4 cases in breast reconstruction group while in none in breast-conserving group, but the difference did not reach a statistical significance (P=0.079); no significant differences were noted in incidence rates of hematoma, infection, fat necrosis and tissue contracture between the two groups (all P>0.05). There were no significant differences between the two groups in mental health, physical health and sexual health as well as the degree of subjective satisfaction from the patients for their breast shape (all P>0.05).Conclusion The two surgical approaches have a similar aesthetic effect. Skin flap necrosis is a serious complication in breast reconstruction with prosthesis and mesh, for which latissimus dorsi myocutaneous flap can be used as a remedial treatment. Breast-conserving surgery should be preferentially considered in patients who meet the indications. Nipple-areola-complex sparing mastectomy with one-stage reconstruction using prosthesis and mesh is an alternative option after reasonable evaluation for those with contraindications to breast-conserving surgery but with a requirement for the appearance of the breast.