Breast reconstruction significantly improves the quality of life for women undergoing mastectomy. However, effective decision-making in breast reconstruction is often hindered by knowledge gaps, decision conflicts, and a lack of personalized support. Based on the Ottawa Decision Support Framework, this study develops a theoretical framework integrating dynamic simulation and inclusive design to enhance shared decision-making and empower patient choices. Using survey analysis, statistical modeling, and refined theoretical frame, a prototype system was designed with 3D surgical simulations and personalized decision-support tools. The findings highlight the critical influence of healthcare provider recommendations, social support, and access to visual information on decision-making. Additionally, educational background, occupation, relationship status, and economic factors shape patients’ decision cognition and expectations. The proposed inclusive decision-support system enhances patient engagement, reduces decisional regret, and optimizes healthcare resource allocation. By integrating visual simulations and personalized decision pathways, this framework advances patient-centered care within the Chinese healthcare context to respond the varying needs.