The first cases of video-assisted thyroidectomy and scarless endoscopic thyroidectomy were reported in China in 2001 and 2002, respectively. Breast approach endoscopic thyroidectomy (BAET) has become the most popular procedure for treating thyroid disease in China. Chinese doctors did not pioneer this approach, but contributed toward improvement in technical details such as incision selection, creation of a working space, suture exposure, and control of intraoperative bleeding. Relatively large series confirmed that BAET is a safe procedure but has a long learning curve that can be overcome with training. Surgical stress was not significantly increased despite the larger subcutaneous dissection. BAET to treat malignancy is feasible, but larger series and longer follow-up are warranted before its widespread acceptance.