Objective: To assess the clinical effect of application of endoscopic techniques in axillary lymph node dissection and pedicled greater omental flap breast reconstruction. Methods: The data of 35 patients with stage I and II breast cancer undergoing minimally invasive radical resection plus minimally invasive breast reconstruction were analyzed. The patients underwent endoscopic axillary lymph node dissection and endoscopically assisted tumor quadrantectomy first, and then immediate breast reconstruction by the laparoscopically harvested pedicled greater omental flap through subcutaneous tunnel was performed. Results: The average time for the entire operation was 318 min, in which, the average time for endoscopic axillary lymph node dissection was 41 min, and for laparoscopic pedicled greater omental flap harvest was 59 min, and the average intraoperative blood loss was 75 mL (largely during mastectomy). One case developed partial omental necrosis because the gastroepiploic artery was injured during the operation and only one omental artery was used instead for blood supply to pedicle flap, fat liquefaction of the incision occurred in one case, and in the remaining cases, the greater omental flap survived; no abdominal complications occurred, and the axillary shape as well as upper limb function were satisfactory. The cosmetic outcome was “excellent” in 28 cases, “good” in 6 cases, and “fair” in one case. Conclusion: The endoscopic axillary lymph node dissection combined with laparoscopically harvested pedicled omental flap for immediate breast reconstruction is safe and feasible, and the procedure achieves better results for minimal invasion and aesthetic requirements.