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In this work, an economically feasible procedure was employed to produce poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV)-based foams. Thermally expandable microspheres (TESs) were used as a blowing agent, while bacterial cellulose (BC) nanofibers served both as a reinforcing agent and as a means of improving biocompatibility. PHBV was plasticized with acetyltributylcitrate to reduce the processing temperature and ensure the maximum efficiency of the TES agent. The morphological investigation results for plasticized PHBV foams showed well-organized porous structures characterized by a porosity of 65% and the presence of both large pores (>100 µm) and finer ones, with a higher proportion of pores larger than 100 µm being observed in the PHBV nanocomposite containing TESs and BC. The foamed structure allowed an increase in the water absorption capacity of up to 650% as compared to the unfoamed samples. TESs and BC had opposite effects on the thermal stability of the plasticized PHBV, with TESs decreasing the degradation temperature by about 17 °C and BC raising it by 3–4 °C. A similar effect was observed for the melting temperature. Regarding the mechanical properties, the TESs had a flexibilizing effect on plasticized PHBV, while BC nanofibers showed a stiffening effect. An in vitro cytotoxicity test showed that all PHBV compounds exhibited high cell viability. The addition of TESs and BC nanofibers to PHBV biocomposites enabled balanced properties, along with lower costs, making PHBV a more attractive biomaterial for engineering, packaging, or medical device applications.