Aesthetic breast surgery: a clear and comprehensive guide

“There are different moments in a woman’s life when aesthetic breast surgery may be considered, often linked to natural changes in the body, with needs that may be purely aesthetic or also functional,” explains the Professor.

It is important to consult a plastic surgeon because one feels the need to improve self-esteem and feel better in one’s own body, and for no other reason. Among the most common situations are:

• pregnancy or breastfeeding, when the breasts lose volume and firmness;
• significant weight loss, which can cause breast volume loss and reduce skin elasticity;
• sagging breasts (breast ptosis) related to aging or congenital factors;
• asymmetries and anomalies, meaning evident differences in volume, shape, or position between the two breasts;
• tuberous breast, a congenital malformation characterized by an elongated, “cone-shaped” breast;
• the desire to increase or reduce breast volume;
• improving overall body silhouette proportions;
• large breasts causing back or shoulder pain or limiting movement;
• correction of previous procedures, outdated implants, complications, or unsatisfactory results.

Breast augmentation is the most widely known procedure to increase breast volume and improve shape through the placement of breast implants selected based on the patient’s wishes and the anatomical characteristics of the chest and breasts. The procedure can be performed using different techniques, chosen together with the patient and designed to ensure harmony and long-term stability.

Depending on where the implant is positioned, the main techniques include:

1. Dual Plane

The implant is placed partly under the pectoralis muscle and partly under the breast gland: in the upper portion under the pectoralis muscle, and in the lower portion under the superficial fascia, therefore beneath the breast tissue.

A frequent side effect, more or less evident, is “animation deformity,” meaning movement of the breast and implant when the pectoralis muscle contracts.

This technique is indicated for women at risk of visible implant edges due to limited thickness of the gland and soft tissues. Today it is used only in rare cases.

2. Above the pectoralis muscle

The implant is placed entirely under the superficial fascia, above the pectoralis muscle. It is indicated for women whose gland and soft tissue thickness is sufficient to conceal the implant edges. It can be combined with lipofilling to reduce implant visibility in the upper breast area and cleavage, and to improve the overall aesthetic outcome.

Types of incision for breast augmentation

The incision should minimize the risk of implant contamination and allow the surgeon to clearly visualize and control anatomy. For this reason, the breast gland is avoided, as it is connected to the outside through ducts (small channels that transport milk from the gland to the nipple). The main incision sites include:

• inframammary fold (the natural crease under the breast, considered the best choice);
• periareolar (around the edge of the areola);
• axillary (in the armpit crease).

How the breast implant is chosen

Breast implant selection is based on the patient’s wishes and the anatomical characteristics of her chest and breasts. Anatomical (“teardrop-shaped”) implants provide a more natural appearance with different variables such as:

• diameter;
• height;
• breast projection.

The implant diameter must respect body proportions in order to avoid aesthetic or functional issues. It is mainly calculated based on chest width (from one side of the breast to the other) minus the distance between the breasts (midline distance).

Within these limits, the patient can express her preferences regarding volume and shape: height, projection, and final appearance.

Mastopexy is the procedure that restores shape and firmness to sagging breasts by removing excess skin and reshaping internal tissues to maintain a natural and harmonious appearance, with discreet and proportionate scars.

It does not increase volume, but it can be combined with an implant if more fullness is desired.

To determine when it may be appropriate, a reference parameter is the jugulum-to-nipple distance (the measurement between the jugular notch—the depression at the base of the neck and the center of the nipple): if it is greater than 22 cm, surgery is often recommended (although each case must be assessed based on the woman’s height and proportions).

“To understand whether it is necessary,” explains the Professor, “I also use another simple test: I ask the patient to raise her arms; if the inframammary folds are not visible, mastopexy is unavoidable.”

Depending on the incision type, the main techniques include:

• Vertical: indicated for mild ptosis; it involves an incision around the areola and a vertical line down to the inframammary fold. This lifts the breast tissue and nipple upward, reducing sagging in a targeted way.
• Inverted-T (anchor): for medium to large, sagging breasts. It involves an incision around the areola, a vertical line downward, and a horizontal line along the inframammary fold. This reshapes and lifts the breast, removing more excess skin and redistributing tissue more effectively. It allows optimal remodeling.
• Round block: the incision is performed only around the areola, lifting only the nipple upward without removing much skin. Risk: the breast may appear flatter because the breast cone (the central portion responsible for projection and fullness) is not reshaped.

This technique combines lifting with breast volume enhancement. In cases of small breasts, implants are added to mastopexy. In medium to large breasts, the breast gland itself can be reshaped to increase fullness (auto-implant mastopexy) without using implants.

“To decide whether to use an implant,” continues the Professor, “I ask a simple question: ‘Are you satisfied with your breast volume when wearing a bra?’”

• if the answer is yes: mastopexy with auto-implant (reshaping the patient’s own tissue) is sufficient;
• if the answer is no: augmentation mastopexy with implants is recommended.

Breast reduction decreases the volume of overly large and heavy breasts, relieving back pain and postural issues. The surgeon removes part of the breast tissue and excess skin, reshaping the breast into a lighter, more proportionate form. It is both an aesthetic and functional procedure.

Incision techniques are the same as those used in mastopexy, but instead of removing only skin, a significant amount of glandular tissue and skin is removed:

• Round block: in addition to lifting the nipple, it allows removal of some tissue to slightly reduce breast volume;
• Vertical: enables removal of a moderate amount of tissue and skin, reducing and lifting the breast at the same time;
• Inverted-T: the most commonly used technique for medium to large and/or sagging breasts, allowing removal of a large amount of tissue and skin, reshaping both size and form.

Breast lipofilling involves harvesting autologous fat (from the patient herself) from the abdomen, hips, or thighs to improve breast shape and fullness. It can be performed alone or in combination with auto-implant techniques, mastopexy, or breast augmentation with implants.

Tuberous breast is a congenital malformation that, with varying degrees of severity, results in a narrow, elongated “tubular” breast shape, with a large and protruding areola and lack of volume, causing breast deformity of different levels of complexity.

Correction involves reconstructive surgical techniques, mastopexy, and glandular reshaping, with or without implants, depending on severity.

When an implant is placed, the body naturally forms a tissue capsule around it. If this capsule becomes too tight or rigid (capsular contracture), the breast may become hard, painful, or deformed.

Corrective surgery may include:

• capsulotomy (incision of the capsule to reduce pressure on the implant);
• capsulectomy (reshaping of the capsule to correct deformities and stabilize the implant), often combined with complete removal of the capsule.

The implant is always replaced.

Only some minor breast procedures can be performed under local anesthesia with sedation, such as small reshaping procedures, lipofilling, or scar revisions.

For all other procedures, general anesthesia is recommended.

Recovery timelines after aesthetic breast surgery vary depending on the procedure, but generally it is recommended to:

• rest during the first 48 hours;
• wear a supportive bra for at least 6–8 weeks;
• return to work after 2–3 days;
• resume full sports activity after at least 4–6 weeks (always according to medical advice).

Pain is generally mild and manageable with over-the-counter medications. Post-operative follow-up visits are essential to monitor healing and ensure a safe and stable result.

Aesthetic breast surgery is an invasive procedure, and like any surgical act, it carries both general and specific risks.

General complications, as with all surgeries, are rare but possible. Specific complications are related to the techniques used and, in the case of breast augmentation or augmentation mastopexy, to the use of breast implants.

The pre-operative specialist consultation is a central and essential part of the surgical pathway. It lasts approximately 45–60 minutes and allows the surgeon to listen to the patient’s wishes, assess anatomical characteristics, and clearly discuss the available surgical options.

During the visit, mirror drawings may be used, implant types are presented, and the criteria used to define implant size and shape are explained. During the consultation, the patient will receive informed consent forms and the implant booklet that will be used.

This documentation must be brought to the second pre-operative visit, which is mandatory and free of charge, to review what was discussed and ensure that the patient proceeds with full awareness.

“Breast surgery must be approached with the utmost seriousness. It is essential to rely on surgeons experienced in plastic breast surgery, who use certified materials and operate in authorized and safe facilities,” concludes the Professor.

Very low-cost offers may seem attractive, but often conceal significant risks and compromise both safety and the quality of the outcome. When it comes to health, price should never outweigh patient protection.

Breast plastic surgery at Casa di Cura La Madonnina always places the patient at the center. Each procedure is planned based on individual needs, with the aim of achieving optimal results both aesthetically and functionally, ensuring safety, precision, and long-term durability. The facility combines specialized expertise, advanced technologies, and personalized care, offering safe procedures and reliable results.