Author: Dr. Santanchè Paolo

Date: 10/06/2020

An increasing number of women are interested and read up on the subject of breast augmentation surgery to improve the appearance of their breasts. It is true that cosmetic surgery has made great strides in the development and practice of increasingly refined surgical techniques and technologically advanced implants, offering safer and less invasive solutions for the breasts. The developments made both in surgical techniques and implants for breast augmentation are now able to create breasts that always live up to patients' expectations and are perfectly in harmony with their bodies. Of course, you cannot ignore the skill of the surgeon: you need good ingredients, but without a good cook... even the best products will be wasted.


The various surgical techniques for breast augmentation surgery

As Dr. Paolo Santanchè, a specialist in cosmetic plastic surgery, explains, it is increasingly common for patients to wonder what is the best technique to perform breast augmentation surgery, and get improved breasts through the use of implants. They wonder whether a retro glandular, or submuscular or dual plane technique is preferable, and then again whether periareolar, submammary or axillary access is preferable. According to Dr. Santanchè, it is of extreme importance to specify that the evaluation of which technique to use in breast augmentation surgery is entirely up to the plastic surgeon, who in turn will identify the most suitable type of implant and the most suitable position of the implant, retrogandular or retromuscular or dual plane, depending on what you want to achieve considering the essential starting point.

"Certain aspects of the breast augmentation technique cannot be applied to everyone, since a certain kind of implant and a certain position of the implant may be indicated for one person, but for another they are not necessarily valid and therefore another type of implant and another position of the implant is required in the breasts" explains Dr. Santanchè.

The access route to the breast in cosmetic breast augmentation surgery does not affect the breast augmentation technique with which to insert the implants: therefore, the same implant technique and the same type of implant that can be used submammally, can also be achieved from the periareolar or axillary route.


Breast augmentation surgery through the axillary route

As Dr. Santanchè explains, for breast augmentation surgery the choice of access route for the implants therefore depends mainly on the choice of the surgeon, and above all on their ability. The axillary, or transaxillary, route makes it possible to obtain scar-free breasts, hiding them in an area that is not very visible and with optimal scarring. This technique must be performed through the use of endoscopy via the axillary route, as it is necessary to be able to see every detail of the pocket to be set up in the breast to house the implants, using a fibre optic camera. Breast augmentation surgery via axillary endoscopy therefore, according to Dr. Santanchè, is not only the most technologically advanced surgery, but it actually offers several advantages, as it allows for increased precision imaging and the use of axillary access, which is further away from the breast and is the most concealed incision point: therefore, you will have a breast that is extremely difficult to distinguish from a natural one. Even for an expert.

A further plus of this access route for breast augmentation, according to Dr. Santanchè, is that of being able to have a complete and increased view of the operating field, enabling greater precision and thus creating a perfect pocket in the breast to house the implants, effectively improving the appearance of the patient's breast, without necessarily having to compromise the presence of the surgeon's hand. To clarify some "misinformation" given by some surgeons to patients, there are no contraindications to the axillary route, except for the inability of the surgeon! Any anatomical or ergonomic implant of any size can be implanted via the axillary route in cosmetic breast augmentation.

Breast augmentation surgery through the axillary route

This is the most invasive approach and the one that places the scar in the most delicate and the most visible place "at certain times".

Breast augmentation surgery via the submammary route

This is the easiest way to gain access for breast augmentation surgery. It should only be reserved for secondary and reparative procedures and cases in which total removal of the old periprosthetic capsule from a previous mastoplasty is required. This is the route chosen by less experienced surgeons.

Another element at the centre of numerous concerns for patients who choose to undergo breast augmentation surgery, observes Dr. Santanchè, is the type of prosthesis to be implanted in the breast: round implants, anatomical implants, polyurethane implants or ergonomic implants. Based on Dr. Santanchè's clinical experience, the choice is often narrowed down to anatomical and ergonomic implants.

Anatomical implants are manufactured by several companies and have been used for more than twenty years, since 1995. They must be implanted in almost all cases in a dual plane submuscular position. They remain the preferred choice in severely "empty" or "deflated" and slightly sagging breasts (pseudo-ptosis), bordering on mastopexy.

Ergonomic implants are the most technologically advanced product. Given their exceptional softness and innovative dynamic gel, they enable an implant that is almost always retro-glandular, more anatomical, less invasive, less painful and with half the recovery time. The nano-texturing of the surface of the implants effectively counteracts the risk of capsular contracture. Today, these implants provide the most natural results and breasts that are difficult to distinguish from natural ones, even in the eyes of an expert.

Today, round implants are completely outdated. They are still used in cheaper surgery, given the lower cost, and by less experienced surgeons, given the greater ease of implantation. They do not provide a very natural look due to the overly round shape on the upper part of the breast.

Polyurethane implants are the most rigid, they can hardly ever be implanted via the axillary route. They require a longer incision and if at first they seem to be able to solve the most difficult cases of relapsing capsular contracture, they have a fairly high rate of delayed implant encapsulation. They are used by a small percentage of surgeons who are "fond" of this type of implant.

A fundamental part of any breast augmentation surgery to improve the appearance of the breasts is that in each case the patient must ask the surgeon for a certain type of result, not a certain type of technique.

Obviously, at the basis of everything there has to be the choice of an experienced surgeon: a surgeon who is not capable of implanting an anatomical implant or who is not able to perform breast augmentation surgery via the axillary route, will certainly not recommend it and will find a thousand excuses to recommend a round implant via the submammary route!

Breasts that are more in harmony with the patient's anatomy and body, without neglecting the psychological aspect, without distortions or signs that might indicate the use of breast augmentation is the ideal result.

Santanchè Paolo


Dr. Santanchè Paolo

Medical Surgeon
Milano (Italy)

Profile Contact

Ask a free consultation to the author

Dr. Santanchè Paolo

Related articles


Author : Dr. Francesca Palumbo Breast augmentation surgery is a very popular type of surgery among young and older women alike. This surgery is...

What is breast augmentation?

Breast augmentation surgery is a procedure through which we exclusively modify the volume of the breasts without affecting any physiological...


Dr. Carfagna Rocco

(maximum 1000 characters)

Comment on the article