Abstract: ObjectiveTo investigate the effects of structured drawing art therapy on postoperative anxiety, depression, and posttraumatic growth in patients with breast cancer undergoing immediate breast reconstruction, and to observe changes in vital signs before and after the intervention.MethodsA prospective, nonrandomized controlled study with phased implementation was conducted. By convenience sampling, 78 patients with breast cancer who underwent immediate breast reconstruction at Peking Union Medical College Hospital between May 2025 and August 2026 were enrolled, including 37 in the intervention group (structured drawing art therapy) and 41 in the control group (picture coloring). A total of 68 patients completed the study and were included in the complete-case analysis (32 in the intervention group and 36 in the control group). The Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), and Chinese Posttraumatic Growth Inventory (C-PTGI) were administered before and after the intervention, and systolic blood pressure, diastolic blood pressure, and pulse were measured. Analysis of covariance (ANCOVA) was used to compare post-intervention data between the two groups, and change-score analysis was performed as a sensitivity test. For vital signs, the mean of three pre-session measurements and the mean of three post-session measurements were calculated for each patient, and exploratory between-group comparisons were performed.ResultsAfter adjustment for baseline scores, the intervention group had SAS scores 5.38 points lower (95% CI: -8.29 to -2.47, P < 0.001) and SDS scores 5.14 points lower (95% CI: -8.97 to -1.30, P = 0.009) than the control group, while the total C-PTGI score was 9.13 points higher (95% CI: 4.84 to 13.43, P < 0.001); the corresponding standardized effect sizes (Hedges’ g) were -0.89, -0.65, and 1.02, respectively. Change-score analysis showed that the reduction in SAS scores and the increase in total C-PTGI scores were greater in the intervention group than in the control group, with between-group differences in change scores of -5.55 points (95% CI: -9.95 to -1.15, P = 0.014) and 9.11 points (95% CI: 4.32 to 13.90, P < 0.001), respectively. No statistically significant between-group difference was found for SDS change scores. No statistically significant differences were observed in adjusted between-group differences or change-score between-group differences for systolic blood pressure, diastolic blood pressure, or pulse.ConclusionsStructured drawing art therapy may be associated with lower short-term postoperative anxiety scores and higher self-reported total C-PTGI scores in patients with breast cancer undergoing immediate breast reconstruction. Depression-related findings should be interpreted cautiously because ANCOVA and change-score analysis yielded inconsistent results. The value of structured drawing art therapy for perioperative psychological support in patients undergoing breast reconstruction still requires further validation through large-sample, multicenter randomized controlled trials with long-term follow-up.