Background: Despite electrocautery's potential benefits in surgical procedures, its application in mammoplasty remains controversial due to concerns about tissue damage and healing outcomes. Objectives: This study aimed to assess the efficacy and safety of electrocautery de-epithelization in mammoplasty compared to traditional surgical methods. Patients and methods: This prospective, randomized, single-blinded controlled trial was executed on 100 females scheduled for mammoplasty. Patients were randomly equally assigned to either electrocautery or traditional scalpel de-epithelization. In the electrocautery group, a low-setting electrocautery tool in "cutting" mode was used in a sweeping motion for precise epidermal removal. In the control group, a size 15 surgical blade was used, with the surgeon following their usual technique for de-epithelization under normal conditions. Results: Electrocautery significantly reduced operative time (77.9 ± 13.93 vs 84.6 ± 16.87 minutes, p=0.033), de-epithelialization time (3.26 ± 1.12 vs 13.2 ± 3.12 minutes, p < 0.001), and blood loss (172.4 ± 48.47 vs 193.6 ± 26.63 ml, p=0.008) compared to traditional methods. Both groups showed comparable postoperative pain scores, wound healing time, and complication rates (hematoma formation, surgical site infection, or nipple-areolar necrosis). Conclusions: Electrocautery de-epithelization demonstrated superior efficacy in mammoplasty while maintaining comparable safety profiles to traditional surgical methods.