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Background: Vacuum-assisted excision (VAE) of benign breast lesions is increasingly adopted owing to its clinical performance and convenience. However, the potential complications, impact on patient experience, and healthcare costs need to be thoroughly addressed, which is the focus of this study. Materials and Methods: The Swedish VAE trial was a prospective, single-blind, randomised trial. The patients were randomised to 7G or 10G needle size groups, and VAE was performed under ultrasound or mammographic guidance. Patient acceptance of the method and short-term complications were documented 7 and 15 days after the procedure. Long-term follow-up examinations were performed at 6 and 24 months after the procedure. The total procedural costs were calculated and compared with those of open surgical excision (OSE), the previous standard of care for surgical procedures. Results: In the trial, VAE was performed on 208 patients, of whom 178 answered a questionnaire regarding their experience. Among those, 87 and 91 had their procedure performed with a 7G and 10G needle, respectively. There were no significant differences in pain levels (p = 0.713), complications (p = 0.724), or patient acceptance of the procedure between the two groups (p = 0.401). Fifty-five per cent (98/178) of all patients reported pain levels < 2 on a visual -analogue scale ranging from 1 to 10, while 12 per cent (21/178) reported pain levels >6. Ninety-seven per cent (173/178) of the patients would recommend the procedure to others. The total hospital procedural cost of VAE was estimated to be 60 % lower than the cost of OSE (p < 0.001). Conclusion: The VAE procedure using a 7G needle size was well -accepted by patients and conferred no increase in complications, including pain, compared to a 10G needle size. The VAE procedure had superior cost-efficiency compared to OSE.