Trans-Umbilical Breast Augmentation
of breast implants through the belly button, which is referred to as trans-umbilical
breast augmentation (TUBA), is a controversial procedure and carries with it a
high-risk profile and many trade-offs; such as solely being able to use saline
implants. Additionally, the surgeon
needs to dissect the pocket blindly, which makes the procedure less
precise. Pocket dissection is a critical
step in order to position the implant correctly. Therefore, because this step
in TUBA is done blindly, it leads to higher rates of complications.
a plastic surgeon I understand the appeal of minimizing visible scarring.
professional ideology and how I approach all my patients is to deliver
excellent reproducible results, which are done safely, with minimal
postoperative issues. I can achieve
these results with a minimal visible scar using an infra-mammary incision. Therefore,
I do not perform nor recommend breast augmentation through the belly button to
Trans-umbilical breast augmentation
Breast augmentation performed through the belly button is called trans-umbilical breast augmentation or TUBA. In this procedure an incision is made at the top border of the belly button. A hollow tube is then pushed through the fat layer under the skin from the belly button up to the bottom of the breast. Through this tube a space is created either under the breast tissue itself or under the muscle layer. An inflatable temporary device attached to a long filling tube is then pushed through the hollow tube into the breast pocket. This device then expanded to help create the pocket. After the pocket is created an empty saline implant attached to a long fill tube is pushed through the hollow tube and placed in the pocket. The saline implant is then filled and the attached fill tube is then removed. The implant is designed so that it seals itself after the fill tube is removed from the valve in the implant. The TUBA procedure remains controversial and is not widely recommended. Although seems ideal to minimize the visible scarring associated with breast enhancement the trade-offs are significant. With this procedure only saline implants can be utilized. The pocket is created bluntly from a remote location limiting the precision of pocket dissection. The precise creation of the ideal pocket for each patient is the key to the creation of an ideal breast shape. Because of the limited precision in creation of the pocket the revision rate of this procedure is significantly higher than other procedures done under direct vision. When the pocket is created bluntly there is more chance for postoperative bleeding. Even a small amount of blood remaining in the pocket can cause future capsular contracture. Another potential problem with this procedure is scarring in the fat tissue through which the dissection tube is placed. This can leave a permanent mark extending from the belly button up to the breast. Most patients are selecting silicone implants and would prefer a technique which results in a more predictable outcome and less chance for need for future revisional surgery.
TUBA Breast Augmentation
In plastic surgery there is always the quest for the next best technique,device or procedure. Most unfortunately do not withstand the test of time and professional scrutiny. TUBA augmentations where tauted as a scarless way to augment the breast, but even in experienced hands the revision rate was unacceptablly high and you had limitations on implant type and size. Plastic surgeons and patients are not fond of revisions and when necessary are performed through a traditional approach. You always want a technique that delivers consistent excellent results and not the latest fad which is why most experienced surgeons avoid the TUBA procedure.
Trans Umbilical Breast Augmentation has not gained wide spread popularity because, even in the best of hands, the procedure has a high complication rate, a high revision rate and limits the patient's implant choices. Certainly patients and surgeons alike wish to minimize scarring but not at the expense of complications and/or a suboptimal result. The overwhelming majority of board certified plastic surgeons share the view that the umbilical approach to breast augmentation is not in the patient's best interest.
TUBA - Breast Augmentation Through the Belly Button?
If you desire a truly scar-less Breast Augmentation that leaves virtually no scars on the chest, then you may wish to consider Trans-Umbilical-Breast-Augmentation (TUBA). The implant is placed via an incision hidden in the belly button. This leaves no visible scar anywhere near the breast. (Even the armpit incision can sometimes be very visible in a bathing suit or strapless top or dress.)
Recent advances in instrumentation make it possible to perform the operation placing the implant either above or below the muscle. As there is no cutting of tissue over the ribs, patients experience much less pain and quicker recovery – even with placement under the muscle. The TUBA procedure requires a higher level of skill and training, which is why most plastic surgeons do not perform it.
Breast Augmentation Placement
This is a good question as the majority of patient that wish
to have a breast augmentation desire a result that is going to feel and look
natural without having obvious scars.
There are several ways to place the incision so that it is
well hidden in natural skin folds or breast transitions.
- a.Hidden at the natural transition from the areola
and the breast skin. The incision can be
hidden in this natural color transition
- 2.Inframmary Fold
- a.The incision is hidden in the fold below the
- a.The incision for the implant can be hidden in
one of the natural axilla folds.
- a.This technique has become less popular as only
saline implants can be place using this method.
- b.Also patients run the risk of destroying the
fold, which can cause their implant to drop overtime.
It is important to see your board certified
plastic surgeon to help guide you to an implant that will give you an
aesthetically pleasing breast.
Transumbilical breast augmentation is not popular because it makes placement of the implants more difficult. Only saline implants may be used as well since the path to the breasts has to be small, allowing only for an implant shell.
Transaxillary (armpit) endoscopic augmentation is the way to go!
From a technical standpoint, it is much better to approach the sub muscular space from above, meaning in the armpit. A surgical camera placed via the armpit gives an excellent view of the space, and the scar is hidden in the axilla. The implants are easily inserted using this approach. Via the belly button, the surgical camera is introduced from below, and the sub muscular space must be approached aiming at the chest wall. It is also a loner distance to push the implants, which can weaken the implant shell. Because there is no significant advantage of the belly button scar over the armpit scar, it does not make sense to use an approach (belly button) which has theoretical, practical and technical limitations.
Belly button for breast implants
The biggest reason I do not use this incision is I prefer the look and feel of silicone breast implants, which cannot be inserted through the belly button.
Breast Augmentation: Transumbilical Augmentation Vs. Transaxillary Infra-Mammary or Peri Areolar Incisions
transumbilical approach to breast augmentation has advocates, but the vast
majority of plastic surgeons prefer other surgical approaches. Surgeons, who prefer the transumbilical
approach, feel that this procedure has the major advantage, of less
scarring. They believe that
transumbilical incisions heal imperceptibly. They acknowledge that there’s a steep learning curve with
this procedure and that there are potential problems with implant malposition. There’s
no question that excellent results can be obtained with this procedure.
majority of plastic surgeons prefer the transaxillary infra-mammary or peri
areolar incisions. They feel that
these incisions are associated with a decreased incidence of implant
malposition. They also feel that
scarring with these incisions is rarely a problem.
feel that the probability of implant malposition with transumbilical incisions
is higher than the probability of adverse scarring with traditional breast
important to realize that surgeons have different comfort levels with different
incisions. They do their best work
when they are able to use their preferred incision. Although good results can be obtained with transumbilical
incisions there’s probably a good reason why the majority of plastic surgeons
prefer traditional surgical approaches.