Objective To systematically sort out the research status, hotspots and development trends in the field of fertility-related decision-making conflict and support needs among breast cancer patients using bibliometric methods, so as to provide references for subsequent research and clinical practice. Methods Based on the Web of Science Core Collection, relevant studies on fertility-related decision-making conflict and support needs among breast cancer patients published from 1995 to 2025 were retrieved. Excel 2021, CiteSpace 6.3.R1 and VOSviewer 1.6.19 were used to analyze the elements including countries, institutions, authors, journals and keywords. Results A total of 1113 publications were included. Early-stage publication output increased slowly, its growth rate rose significantly after 2007, and reached a peak of 116 publications in 2025. The United States accounted for 43.8% of total publications, and Harvard University and its affiliated institutions were the core contributing forces. Core journals showed interdisciplinary characteristics, while highly-cited literature was highly concentrated in the field of oncology. Keyword analysis revealed that research themes fell into three categories: clinical epidemiology and genetic risk research, therapeutic intervention and fertility preservation research, quality of life and support needs research. Quality of life and support needs may be future research hotspots. Conclusions The field of fertility-related decision-making and support for women with breast cancer has evolved into a multidisciplinary research frontier, with its research focus shifting from biomedical and technical discussions toward patient-centered decision-making support and humanistic care. Further in-depth research could be carried out targeting hot topics in the future to promote the development of this field toward precision and intelligence.