Objective To compare the complications and satisfaction of immediate implant reconstruction and open surgery after endoscopic mastectomy. Methods From January 2019 to May 2022, 96 patients with early breast cancer who underwent immediate postoperative breast reconstruction were treated in our department. There were 36 cases in the endoscopic surgery group and 60 cases in the open surgery group. Nonparametric test, Mann-Whitney U test, and Logistic regression analysis were used to compare the age, tumor location, surgical method, histological grade, neoadjuvant chemotherapy, adjuvant chemotherapy, radiotherapy, Whether the nipple and areola are preserved, whether there are complications, whether there is local recurrence and related factors of satisfaction.Results The age and histological grade of the two groups were not statistically significant by nonparametric test（P＞0.05）There were significant differences in the composition ratio of tumor location, neoadjuvant chemotherapy, and nipple and areola preservation（P＜0.05）There was no significant difference in the composition ratio of surgery, adjuvant chemotherapy, adjuvant radiotherapy, postoperative complications and local recurrence among different groups by test (P＞0.05) In univariate Logistic regression, sentinel lymph node biopsy, axillary lymph node dissection, neoadjuvant chemotherapy, adjuvant radiotherapy, and nipple and areola preservation were associated with complications after immediate breast reconstruction (P＜ 0.05)Multivariate analysis suggested that axillary lymph node dissection, prosthesis volume, high blood pressure, nipple and areola preservation were relatively independent factor for the incidence of complications. Conclusion Endoscope-assisted subcutaneous mastectomy with single-port inflatable and prosthesis implantation with stage I breast reconstruction is safe and feasible for eligible breast cancer, including the advantages of minimally invasive, low incidence of complications and related risks can be controlled, better radical effect and cosmetic effect can be achieved, the quality of life and satisfaction of patients are higher, which can be promoted in clinical application