Objective To explore the effect of ultrasound-guided vacuum-assisted minimally invasive rotary excision system on breast aesthetics in patients with benign breast tumor. Methods By using the random number table method, 60 patients with benign breast tumor admitted to our hospital from May 2023 to May 2024 were divided into the control group (minimally invasive rotary excision system surgery) and the study group (ultrasound-guided vacuum-assisted minimally invasive rotary excision system surgery), with 30 patients in each group. The perioperative indexes (operation time, intraoperative blood loss, incision healing time, hospitalization time), breast aesthetics, complication rate and serum pain factor indexes were compared between the two groups. Results Compared with the control group, the perioperative indexes in the study group were better (P <0.05). Compared with the excellent and good rate of breast aesthetics in the control group (73.33%), the excellent and good rate of breast aesthetics in the study group was higher, reaching 96.67% (P <0.05). Compared with the incidence of complications in the control group (33.33%), the incidence of complications in the study group was lower, accounting for 6.67% (P <0.05). Compared with the serum pain factor indexes (NPY, 5-HT and PGE2) in the control group, the above indexes in the study group at 3 days after operation were lower (P <0.05). Conclusion The application of ultrasound-guided vacuum-assisted minimally invasive rotary excision system in the treatment of benign breast tumor can effectively shorten the operation time, reduce intraoperative blood loss, promote incision healing, shorten the hospitalization period, maintain good breast appearance aesthetics, reduce the incidence of postoperative complications, and relieve postoperative pain in patients.