Breast 4a surgery open and minimally invasive have their own benefits, usually should be combined with the specific condition and the patient’s wishes and other factors to consider. Generally, nodules smaller than 2cm are suitable for minimally invasive, while nodules larger than 2cm are better to be directly removed by open surgery to avoid residual recurrence. Breast nodule according to ultrasound or molybdenum target examination to determine its nature can be divided into 0 ~ 6, of which, grade 4 is divided into three grades (4A, 4B, 4C), 4A refers to the degree of malignancy is not more than 30%. Breast 4A, if the nodule is less than 2cm, the benefits of using minimally invasive are greater, both to achieve the aesthetic requirements, but also to achieve a better therapeutic effect. For 4A breast, if the nodule is larger than 2cm, minimally invasive may not be able to cut cleanly, the possibility of postoperative bleeding will increase, the residual recurrence is easy to occur, and there is a certain degree of malignant changes in 4A nodules, so it is better to choose open surgery to completely remove the nodule. Whether to choose minimally invasive or open approach, usually should be combined with the specific condition and the patient’s wishes and other factors to consider, generally suspected of malignant mass or malignant mass can be removed patients, the surgical approach should be to improve the survival rate as the primary purpose, then consider the appearance. Therefore, minimally invasive and open breast 4A surgeries have their own advantages, and patients should choose the appropriate surgical method for their condition under the guidance of their doctors.