This study aims to explore the composition and dynamic changes of symptom clusters in breast cancer patients at various time points after breast reconstruction, offering insights for better symptom management post-surgery. A total of 120 breast cancer patients who received breast reconstruction surgery at our hospital from January 2021 to October 2023 were included in this retrospective study. Information regarding patient demographics and disease characteristics was gathered. The Chinese version of the Memory Symptom Assessment Scale to evaluate patients at admission (T1, 120 cases), 1-day post-surgery (T2, 116 cases), 1-week post-surgery (T3, 111 cases), 1-month post-surgery (T4, 104 cases), 3 months post-surgery (T5, 84 cases), 6 months post-surgery (T6, 76 cases) and 12 months post-surgery (T7, 64 cases). At each time point, there were 15, 17, 19, 16, 13, 12 and 9 symptoms respectively, with a prevalence rate exceeding 20%. The analysis through exploratory factorization disclosed that the peak prevalence of symptoms over 20% was observed at T3. Factorization of all symptoms at T3 delineated 6 distinct clusters of symptoms: autonomic dysfunction, fatigue, somatic dysfunction, psychological dysfunction, neurological and sensory symptoms and sleep-related symptoms. Breast cancer patients undergoing breast reconstruction experience multiple symptom clusters. The core symptoms within these clusters remain relatively stable over time. Healthcare professionals should conduct dynamic assessment and strengthen the coordinated management of these symptom clusters.