In the treatment of benign solid breast lumps, traditional mastectomy often leaves scars and deformities in the breast that affect the appearance. In the case of non-palpable masses, traditional surgery is not easy to achieve the goal of diagnosis and treatment because of the difficulty of localization. This study was conducted to address this surgical challenge. OBJECTIVE: To investigate the value of vacuum-assisted spinotomy for the diagnosis and treatment of solid breast masses that are benign on ultrasound. METHODS: From January 2008 to June 2009, 831 patients with benign solid breast masses with Breast Imaging Reporting and Data System (BI-RADS) grade 2, 3, or 4 on ultrasound were collected from our breast center, and all patients underwent vacuum-assisted minimally invasive rotational surgery. The ultrasonographic, surgical and pathological data of the patients were retrospectively analyzed. RESULTS: According to the BI-RADS classification of ultrasonography, there were 167 grade 2, 588 grade 3, and 76 grade 4 cases. 1383 masses were detected in 831 patients, and all breast masses were accurately and completely excised, all patients had concealed incisions, no breast deformation, and good aesthetic results. 822 benign lesions were found in 831 patients, accounting for 98.92% of all cases. Breast cancer was detected in 9 cases, accounting for 1.08% of all cases, including 8 cases of clinical stage I and 1 case of stage IIa. 1 case of breast cancer was detected in 418 patients with non-palpable masses, accounting for 0.24% of non-palpable patients and 0.12% of all cases (1/831). 8 cases of breast cancer were detected in 413 patients with palpable masses, accounting for 1.94% of palpable patients and 0.96% of all cases (8/831). Three breast cancers were detected in 588 BI-RADS grade 3 cases and 6 breast cancers were detected in 76 BI-RADS grade 4 cases. Conclusion: Vacuum-assisted spinotomy minimally invasive surgery for the diagnosis and treatment of benign solid breast masses by ultrasound is not only cosmetically effective, but also accurately localized to allow total excision of benign lesions and, more importantly, to detect early breast cancer in clinically considered benign masses.