Breast Augmentation Through the Belly Button?

I have seen this procedure on television, but with the consultations I've had with doctors, no one really seems to want to do it. Is there a reason why? I know the best incision option for me would be through the areola since one of mine is larger than the other and that could be corrected at the same time. But if it wasn't for that, I would want to go through the belly button due to no detectable scarring. Why is this procedure not as popular?

Doctor Answers 33

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. 

Michael B. Tantillo, MD
Boston Plastic Surgeon
4.5 out of 5 stars 21 reviews

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.
  • 1.Periareolar
    • 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 breast.
  • 3.Axilla
    • a.The incision for the implant can be hidden in one of the natural axilla folds.
  • 4.Umbilical
    • 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. 

Grant Stevens, MD
Los Angeles Plastic Surgeon
4.5 out of 5 stars 86 reviews

Breast Augmentation: Transumbilical Augmentation Vs. Transaxillary Infra-Mammary or Peri Areolar Incisions

         The 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.


         The 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. 


         They feel that the probability of implant malposition with transumbilical incisions is higher than the probability of adverse scarring with traditional breast augmentation incisions. 


         It’s 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.  

Not everyone is an expert

The issue with Trans-umbilical Breast Augmentation is that since its done almost "blind", most surgeons are too afraid to even attempt it. It requires a degree of skills that only a few doctors in the world have, including my good colleague Dr. Hasan who created and pioneered the procedure. The procedure is done blind and the measurements are very difficult to manage. Most doctors avoid it our of fear or lack of skills.

Jonathan Fisher, MD
Miami Plastic Surgeon
4.5 out of 5 stars 515 reviews

Popularity of TUBA

I have been doing the TUBA procedure for over twenty years now on patients from all over the world.  The results are excellent in the right hands.  As you read through the responses to this question, you will see a lot of negative things written about the TUBA procedure.  I think these doctors have either never done a TUBA procedure or have never seen one done.  I have had many doctors come to observe me do this procedure and they all leave the O.R. shaking their heads at how easy this procedure is. Why isn't this procedure more popular with doctors?  I have several theories:  1. Doctors tend to be trained in one or two approaches for breast augmentation.  They become comfortable with that approach and don't want to try anything new.  They also don't want to lose patients to doctors who DO perform the TUBA so they simply downplay this approach.  2. Despite the fact that the TUBA approach utilizes well-established concepts that have been around since the 1970's, the doctor who specifically developed the TUBA approach is not a board-certified plastic surgeon so the community of plastic surgeons tends to dismiss his idea outright without ever giving it a chance.  If someone in the hierarchy of plastic surgery had developed this idea, I can guarantee you that EVERYONE would be using this approach.  3. Because most plastic surgeons tend to ignore this approach, the door is open for "cosmetic surgeons" who get their training from weekend courses to exploit this approach for their own use.  Because they are poorly trained, the risk of bad outcomes is greater.  When bad outcomes occur, mainstream plastic surgeons can point and say that it is a bad procedure, not that there are poorly-trained doctors performing the procedure.

Again, as with any procedure, IN THE RIGHT HANDS, this is an excellent approach to putting in saline breast implants either above of below the chest muscle.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 14 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.