To investigate the effect of endoscopic breast augmentation with ultrasonic scalpel. Methods From January 2020 to June 2023, 208 female patients who underwent endoscopic breast augmentation in our hospital were selected as the research objects. According to the random number table method, they were divided into control group and observation group, with 104 patients in each group. The control group was treated with high-frequency electric scalpel, and the observation group was treated with ultrasonic scalpel. The perioperative related indexes, postoperative pain degree, surgical satisfaction and complications were compared between the two groups. Results The intraoperative blood loss in the observation group was lower than that in the control group, and the operation time was shorter than that in the control group (P <0.05). The VAS scores of the observation group were lower than those of the control group at 1, 3 and 7 days after operation (P <0.05). The surgical satisfaction of the observation group was 99.04%, which was higher than 87.50% of the control group (P <0.05). The incidence of postoperative complications in the observation group was 0.96%, which was lower than 7.69% in the control group (P <0.05). Conclusion The use of ultrasonic scalpel in endoscopic breast augmentation can effectively reduce the amount of intraoperative blood loss, which can be more precise and accurate stripping, relieve postoperative pain, reduce the incidence of complications, and improve patient satisfaction.