Objectives <p>Breast reconstruction improves body image, sexual experience, and well-being in patients with breast cancer. However, only about 10% of patients in China choose breast reconstruction. The objective of this study is to explore types of breast reconstruction decision-making and driving factors among Chinese premenopausal patients.</p> Methods <p>This was a mixed-methods study based on Q-methodology, conducted from May 2024 to October 2024. First, 15 premenopausal breast cancer patients who underwent breast reconstruction were selected using maximum variation purposive sampling for semistructured interviews, generating a Q-sample dataset consisting of 36 statements. Then, 18 premenopausal patients who underwent breast reconstruction were selected as the P-sample using the same sampling method; these 18 patients performed Q-sorting on the 36 statements within a specified Q-sorting grid and completed in-depth interviews after sorting. Data analysis was primarily conducted using Ken-Q software, which automatically generated standardized Q-sort results. Combined with these standardized Q-sort results and interview contents, the study analyzed the decision-making driving types and factors influencing patients’ choices of breast reconstruction.</p> Results <p>Principal component analysis identified six factors with eigenvalues &gt; 1, collectively accounting for 72% of the total variance. Based on the ideal Q-sort simulated by the software, three types of decision-making factors were identified. The social participation and youth advantage co-dominant type was motivated by professional advice, younger age, and social engagement. The aesthetic appearance and case-based encouragement co-dominant type was driven by a desire for body image, aesthetics, and the influence of other’s successful surgeries. The medical professional advice and financial status co-dominant type was shaped by trust in medical professionals, confidence in the healthcare team, and financial considerations.</p> Conclusions <p>Premenopausal patients with breast cancer in China who underwent breast reconstruction demonstrated various decision-making types. The findings may assist Chinese healthcare providers as well as healthcare providers in other countries with similar Eastern cultural backgrounds in understanding and exploring the drivers of breast reconstruction choices during shared decision-making processes. This work can help in developing targeted interventions and establishing clinical protocols that empower patients to make choices that align with their preferences and best interests.</p>