Objective To explore the efficacy and safety of modified small-incision minimally invasive surgery in the treatment of bromhidrosis. Methods A total of 82 patients with bromhidrosis admitted to the Department of Plastic Surgery, the First People's Hospital of Guiyang from June 2023 to June 2025 were selected. According to different treatment methods, they were divided into the control group and the observation group, with 41 patients in each group. The control group was treated with the traditional axillary fold incision minimally invasive method, and the observation group was treated with modified small-incision minimally invasive surgery. The clinical indicators, clinical efficacy, complications and satisfaction were compared between the two groups. Results The operation time and postoperative recovery time of the observation group were shorter than those of the control group (P <0.05). There was no statistically significant difference in total effective rate between the two groups (P >0.05). The incidence of complications in the observation group (7.32%) was lower than that in the control group (29.27%) (P <0.05). The satisfaction rate of the observation group (95.12%) was higher than that of the control group (68.29%) (P <0.05). Conclusion Compared with the traditional axillary fold incision minimally invasive method, modified small-incision minimally invasive surgery for bromhidrosis has an ideal clinical effect. It can effectively shorten the operation time and postoperative recovery time, reduce postoperative complications, thereby improving patient satisfaction.