Objective To compare the effect of periareolar incision and radial incision on the aesthetic effect in patients undergoing breast fibroadenoma resection. Methods A total of 196 patients who underwent breast fibroadenoma resection in our hospital from March 2023 to March 2024 were selected, and they were divided into group A and group B according to different incision methods, with 98 patients in each group. Group A received radial incision, and group B received periareolar incision. The surgical satisfaction, aesthetic effect, surgery-related indicators and complications were compared between the two groups. Results The scores of BREAST-Q in group B after surgery were all higher than those in group A (P<0.05). The subjective satisfaction score and Harvard Scar Scale score in group B were higher than those in group A, while the POSAS observer score was lower than that in group A (P<0.05). The intraoperative blood loss and incision length in group B were better than those in group A, and the operation time was longer than that in group A (P<0.05). There was no statistically signiffcant difference in hospitalization time between the two groups (P>0.05). The incidence of paresthesia in group B (10.20%) was higher than that in group A (3.06%) (P<0.05). There was no statistically signiffcant difference in the incidence of complications between the two groups (P>0.05). Conclusion Compared with radial incision, periareolar incision in breast ffbroadenoma resection can achieve better aesthetic effect, but this method has longer operation time and higher incidence of postoperative nipple-areola paresthesia. Clinically, the actual needs of patients should be considered. Periareolar incision is suitable for patients with high aesthetic requirements, while radial incision is suitable for patients with large tumors or those who need surgical efffciency.