Background <p>Endoscopic thyroidectomy via extracervical approaches has been developed to avoid anterior neck surgical scars. However, each approach has its own limitations. We developed a novel endoscopic thyroidectomy via the contralateral-axillo-bilateral-breast approach (CABBA-ET) and compared the surgical outcomes with those of open thyroidectomy (OT).</p> Methods <p>We retrospectively reviewed patients who underwent thyroidectomy by the same surgeon between January 2021 and December 2023 at our institution. The surgical outcomes and postoperative complications of CABBA-ET and OT were compared after propensity score matching (PSM) of the clinicopathologic characteristics.</p> Results <p>A total of 433 patients who underwent CABBA-ET or OT were enrolled in this study, of whom 83 underwent CABBA-ET, and the remaining 350 underwent OT. After PSM, 16 pairs of patients with benign thyroid nodules and 56 pairs of patients with differentiated thyroid carcinoma (DTC) were matched between the CABBA-ET and OT groups. Compared with the OT group, patients with benign nodules and DTC in the CABBA-ET group had a longer operation time (both <i>P</i> &lt; 0.01) and a higher 24-h postoperative drainage volume (<i>P</i> = 0.03 and &lt; 0.01). The length of hospitalization was comparable between the two groups, and there were no significant differences in postoperative complications.</p> Conclusions <p>CABBA-ET is a viable cosmetic procedure and may represent an alternative for selective patients.</p>