The questions patients ask me most often, answered clearly: how it works, where the scar will be, how long recovery takes and what result to genuinely expect. The guide by Prof. Alfredo Borriello.
You are looking into breast augmentation and finding different answers everywhere. That is normal: it is a much-discussed procedure, and often badly explained. Here you will find the questions patients actually ask me in the consulting room, answered in order and without beating around the bush.
Over 35 years of practice as a plastic surgeon I have seen one thing repeat itself: a patient who arrives informed is calmer, takes part in the decisions and copes far better with the weeks after surgery. Let us begin.
In short: the procedure takes 1-2 hours, under general anesthesia or local anesthesia with sedation, and as a day-hospital procedure (you go home the same evening). Everyday life resumes in 3-5 days, desk work between day three and day seven, sport from 4 weeks. A support bra is worn for 4-6 weeks. Volume shows immediately, the final shape arrives between 3 and 6 months.
It is the procedure that increases breast volume by inserting an implant behind the gland or behind the pectoral muscle. It is one of the most requested aesthetic procedures worldwide and, in Italy, also one of the most closely tracked.
The goal, though, is not "a bigger breast". It is a volume that is proportionate to your chest, shoulders and hips, with a natural shape. This is why the choice never starts from a cup size, but from your chest measurements: breast base width, distance between the breasts, tissue thickness, nipple position.
There are four common situations: an underdeveloped breast, a loss of volume after pregnancy, breastfeeding or weight loss, a visible asymmetry between the two breasts, or simply the wish for better balance in your silhouette.
One point changes everything: if volume loss comes with a drooping breast (ptosis), an implant alone is not enough and would actually accentuate the droop. That case calls for reshaping the gland and skin too, that is a breast lift with implants. Working out which of the two situations you are in is the most important part of the consultation.
In some situations the right answer is "not now": ongoing pregnancy or breastfeeding, a lump or breast concern not yet investigated with ultrasound or mammography, active autoimmune disease and, not least, unrealistic expectations.
There is also a legal limit: Italian law 86 of 2012 prohibits implants for aesthetic purposes in minors, except for certified severe congenital malformations. Saying "not yet" is as much part of a surgeon's work as operating.
Today's implants have a silicone shell and a cohesive gel filling: a gel that holds its own shape and does not disperse into the tissues even if the shell is damaged.
They are certified medical devices meeting strict European standards. You will receive a document listing brand, model and serial number to keep, along with an information sheet required by law.
On top of that, Italy has a safeguard few patients know about: since February 2023 every implant and every removal is recorded in the Ministry of Health's national breast implant registry, within three days of surgery.
Round implants distribute volume evenly and give a fuller décolletage, with a slight push-up effect. They are the most widely used: being symmetrical, they keep the same shape even if they rotate within the pocket.
Anatomical (teardrop) implants concentrate volume in the lower pole and reproduce the natural breast profile more closely. They are valuable in very deflated breasts and in breast reconstruction.
The truth is that two other parameters decide how natural the result looks, far more than shape does: the implant's base width and profile. That is the heart of the decision, and it is the work done during the consultation, measurements in hand. Finally there is fat grafting, augmentation with your own fat: suited to modest increases, roughly one cup size.
There are three approaches. The inframammary fold is the most widely used: the scar is a few centimetres long and hides in the natural crease under the breast. It also offers the most precise control over the pocket that will hold the implant.
The periareolar approach follows the lower edge of the areola, where the change in colour masks the mark well. It is especially useful when the position of the areola needs correcting too.
The axillary approach leaves no mark on the breast at all, but it is less versatile and not suitable for every case. In every case the scar matures over the following months, becoming progressively thinner and lighter.
Above the muscle (subglandular plane) the result is more projected and recovery is less uncomfortable, but sufficient covering tissue is needed.
Below the muscle (submuscular plane) the pectoralis major covers the implant and masks its edges better: it is the typical choice in slim patients.
Today the most widely used solution is the dual plane, a middle ground: the upper part of the implant is covered by muscle (a soft décolletage) and the lower part is in contact with the gland (a full lower pole). There is no best option in absolute terms: it depends on your anatomy, and during the consultation I explain it to you with the measurements in hand.
Before. During the consultation measurements are taken, tissues are assessed, a simulation of the result is performed and the implant is chosen together. Then come the pre-operative tests (blood work, ECG), the anesthesiology consultation and, if indicated, a breast ultrasound. In the weeks around surgery it is important not to smoke.
On the day. You arrive fasting. After the pre-operative marking done standing up, surgery is performed under general anesthesia or under local anesthesia with sedation: the choice is made together with the anesthesiologist, based on your case and your preferences. The procedure takes on average 1-2 hours. The pocket is created, the implant is positioned and symmetry, shape and projection are checked, including in a semi-seated position. Closure is in layers, with absorbable internal sutures.
After. This is a day-hospital procedure: in most cases you go home the same evening or the following morning, already wearing the support bra.
Recovery is quick and predictable. These are average timings: they can vary depending on the plane chosen and on how your tissues respond.
Tightness across the chest and swelling, peaking on the second day. Relative rest, no strain on the arms, support bra day and night. Discomfort well controlled by medication.
Clear improvement: light daily activities resume and short drives are possible. The first dressing check takes place and, within this window, most patients return to desk work.
Full return to social life. Swelling subsides and tightness eases noticeably. Arm strain and lifting weights should still be avoided.
Gradual return to sport, starting with light cardio; chest exercises come last. The period of continuous support-bra wear ends.
The implants have largely settled: the breast has softened, dropped into its natural position and the lower pole has rounded out.
Final, stable shape. Scars continue to fade and mature, becoming thin and inconspicuous.
In the first weeks the breast looks higher, firmer and fuller at the top than it eventually will. This is normal and temporary: the implants need to settle. The result should not be judged in the first month.
Volume shows immediately, shape comes later. In the first weeks the breast is swollen, tight and very full at the top. Then the tissues relax, the implants drop into their natural position and the lower pole rounds out.
This is what surgeons call settling and it is generally complete between 3 and 6 months. Knowing it in advance removes much of the anxiety of that period: the breast of the first few weeks is not the final one.
A natural result depends more on proportion than on volume. That is why, during a consultation, I sometimes suggest a different volume from the one you had in mind: not to scale down a wish, but because that breast, on that chest, will look better and last better over time.
No, and it is worth saying clearly: breast augmentation adds volume, it does not lift. If the nipple sits below the inframammary fold, an implant alone would accentuate the droop rather than correct it.
In those cases the correct result is achieved by combining a breast lift. Once settled, the result is stable and long-lasting, but the breast continues to be affected by pregnancy, weight changes and the natural aging of the tissues.
Breast augmentation is a standardized procedure with an excellent safety profile, but it remains surgery. These are the possible complications, and it is right to know them beforehand rather than afterwards:
BIA-ALCL deserves a clarification, because it is the fear I hear most often. The Italian Ministry of Health has monitored it since 2015 with mandatory reporting, and the figures show it really is rare: by the end of 2022 just over ninety cases had been reported in Italy.
Most have involved textured surface implants, but the European scientific committee SCHEER has found no evidence of a causal link with a specific type of implant. For this reason neither the Ministry nor the scientific societies recommend removing implants preventively in a patient without symptoms.
First, let us dispel a myth: implants have no expiry date and are not changed "every ten years" as a matter of principle. They are replaced when a problem arises or when you wish to change the result.
What genuinely matters is follow-up over time, because rupture of a silicone implant is often silent, that is symptom-free. The FDA recommends that patients without symptoms have a first ultrasound or MRI 5-6 years after surgery, then a check every 2-3 years.
If symptoms appear or the ultrasound is inconclusive, an MRI follows. Alongside this come follow-up visits and the routine breast screening appropriate for your age.
Drag the slider over the image to compare before and after. These are real cases operated on by Prof. Borriello.
Two before/after comparisons of real cases are shown here in the article.
Photos of real patients published with consent. Results are individual and vary from person to person.
Explore the procedure and related treatments:
The procedure takes on average 1-2 hours and is performed under general anesthesia or under local anesthesia with sedation, as a day-hospital procedure: in most cases you go home the same evening or the following morning. The total time in the facility, including preparation and waking up, is a few hours.
Light daily activities resume after 3-5 days, and most patients return to desk work between day three and day seven. Sport resumes gradually from 4 weeks onwards, leaving chest exercises for last. A support bra should be worn for about 4-6 weeks to accompany the settling of the implants.
Less than you might fear. In the first 48 hours the dominant sensation is not real pain but a feeling of tightness across the chest, very much like the day after an intense chest workout. It is well controlled by the prescribed medication and eases markedly from the third day.
In the vast majority of cases, no: the implant sits behind the gland or behind the muscle and does not interrupt the ducts. One figure does matter when choosing the technique, though: a systematic review published in 2026 in Aesthetic Surgery Journal reports breastfeeding success of 85.9% with the inframammary incision against 63.1% with the periareolar one. It is one of the reasons why, in a young patient who wants children, I prefer the inframammary approach. Ultrasound and mammography are performed routinely: simply tell the centre that implants are present, and dedicated views will be used.
It depends mostly on how much tissue covers them. With good coverage the breast feels natural and the edges of the implant cannot be felt. When tissues are thin, lower profiles and dual plane placement are preferred precisely to mask the edges: it is one of the assessments made during the consultation.
It can be done, at any time. Implants are removed with a simpler procedure than the one to place them, with or without replacement. The breast returns to its previous volume and the final look depends on skin elasticity: when needed, removal is combined with a breast lift to redefine the shape.
A woman in good general health, with completed breast development, who wishes to increase or restore breast volume and has realistic expectations about the result. The most common indications are an underdeveloped breast, volume loss after pregnancy or weight loss, and breast asymmetry. If volume loss is combined with a drooping breast, the correct indication is a breast lift with implants: this is one of the points we assess during the consultation.
A consultation can be booked directly from the website or by phone at Prof. Borriello's practice in Naples. During the visit chest measurements are taken, tissues and any asymmetry are assessed, a simulation of the result is performed and we choose together the implant type, the incision and the placement plane best suited to your case.
Breast augmentation brings great satisfaction when it is tailored to the individual patient: the implant suited to that breast base, the right approach for that anatomy, the plane that makes the most of those tissues. It is in the planning, more than in the operating room, that the quality of the result is decided.
If you are still at the stage of deciding who to trust, you may also find the guide on how to choose a plastic surgeon useful.
If instead you are considering breast augmentation and want to understand which solution would suit you best, book a consultation at our practice in Naples: we analyze your measurements and your goals together and define a clear plan, with realistic timing and results.
This content is intended for informational and educational purposes only. It does not in any way replace professional medical advice, diagnosis, or treatment. For any medical questions or concerns, it is essential to consult your physician or a qualified specialist.
Plan your procedure with Prof. Borriello: during a private consultation we take your measurements, assess your tissues and choose together the implant, the incision and the placement plane best suited to your case.