TUBA Breast Augmentation

I want to do a Transumbilical (TUBA) Breast augmentation. Can use you TUBA procedure to put the implants under the muscle?

Doctor Answers (53)

TUBA's attraction is no scar on the breasts. But a bad augmentation looks worse than no scar!


It should be clear from my colleagues' comments that TUBA is fraught with potential problems that usually occur more frequently than with other incision choices. I know well-trained, experienced, board-certified plastic surgeons who do this operation (TUBA), and do it well. But just because it is possible does not mean it is the best! The surgeons who do this operation can show you many patient photos that will impress you, making you think that perhaps this is indeed a good choice. I can do the same with the other incision choices. But if you asked for the complication rate, re-operation rate, or satisfaction rate for several hundred consecutive patients of each technique, TUBA will have higher dissatisfaction, complications, and re-operations, in my humble opinion, than the other three incision choices.

I believe a carefully and precisely closed incision with fine sutures and below-the-skin closure results in an almost invisible scar in the vast majority of patients. I prefer the incision that allows me to do the most careful pocket creation, control bleeding and resultant pain, bruising, and capsular contracture, and the most accurate implant positioning. This allows the least complications, the fewest re-operations for any reason, and then the scar becomes a truly insignificant concern (even for models and entertainers)! BTW, TUBA patients who require re-operation for virtually any reason require a scar on the breast.

Minneapolis Plastic Surgeon
5.0 out of 5 stars 153 reviews

Umbilical Breast Augmentation Great Method in Experienced Hands


Yes, you can place saline implants with an umbilcal approach under the muscle. And yes, the placement can be done accurately. The vase majority of doctors who claim that you cannot have accurate placement have not even done one breast augmentation with the umbilcal technique. So of course if you don't have experience it would be difficult. All the methods are good for placing breast implants including umbilical and trans- axillary. But if your doctor gives you a million reasons why the areola is better or the crease that probably means he/ she prefers to do it that way. So if you go to that doctor that is the way you should do it. Going with the umbilcal technique does not void the warranty.

David E. Kim, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 52 reviews

With difficulty and only with saline


In my practice, I had the opportunity to operate at the same surgery center with Gerald Johnson,the plastic surgeon who developed TUBA ,and scrubbed with him on a few cases. The technique is primarily limited to sub mammary placement of saline implants. I never saw Gerald place the implants under the muscle. Although there are a few physician who describe sub muscular placement using the TUBA approach, I see more patients with malposition of the implants using this technique, than I have seen patients with a nice result. For sub muscular placement, I use either the axillary, periareolar, or inframmary crease incision. If you're going with saline, the incision is only 3 or 4 cm which is about 1 1/2 inches. With silicone the incision is larger since silicone implants are prefilled.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.0 out of 5 stars 11 reviews

It's possible... but I don't recommend it


In Medicine and Surgery, many techniques are possible. TUBA  surgery is one of these.

With this approach, it's very easy to have problems like malposition, asimmetries, inframmary fold irregularities,....

In other words, in my opinion you will achive a better result with other approaches (inframmamary/ periareolar preferably). I think that it's easier to get a better result after an augmentation mammoplasty (only with aesthetic purposes) using viscoelastic silicone gel implants; GEL implants are incompatible with TUBA approach. ANATOMIC IMPLANTS are also incompatible with TUBA.

Too many drawbacks!

Enrique Etxeberria, MD
Spain Plastic Surgeon
5.0 out of 5 stars 7 reviews

Yes to Subpectoral


Breast implants can be placed under the pectoralis muscle via the umbilical incision (TUBA).  However, there are limitations to the TUBA approach.  Because the incision size is small and located in a remote position, saline implants must be used, you cannot use silicone, it just won't fit.  If you are very thin the path (tracts) from the umbilicus to the breast used to place the implants can develop noticeable scarring.  Also, if you need to have your inframammary crease adjusted during the procedure, which is very common, it is hard, but not impossible to perform through the belly button.

I have been using the TUBA and TABA (trans-abdominal bilateral augmentation) for 10 years and it is a valuable procedure in the RIGHT  patient.  

Good Luck,

David R Finkle, MD

David Finkle, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 50 reviews



Implants placed by the TUBA procedure can be placed under or over the muscle, but are typically placed over the muscle.  I have seen many patients with bad results after this procedure including implant malposition or implants just too tight in the pocket.  In general, the only advantage is the scar.  Often, using this procedure will void the warranty for your implant so I would definitely consider your alternatives. Scott Newman, MD FACS

Scott E. Newman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 27 reviews

Reconsider TUBA


TUBA (Trans-Umbilical Breast Augmentation) is not embraced by most plastic surgeons because there are specific additional risks unique to this approach, including improper implant positioning, either soon after surgery or developing over time.

Before committing to this approach, consult a few plastic surgeons or read more about the complications on the Internet.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.0 out of 5 stars 14 reviews

TUBA Augment


TUBA in my opinion is not the way to go.I have seen several in my practice that looked terrible.Also you can't put silicone in which in my opinion is the best.Also you must check to see if the implant manufacturerwill provide a warranty using this approach.The majority of my augmentations are with the inframammary approach.

Robert Brueck, MD
Fort Myers Plastic Surgeon
5.0 out of 5 stars 29 reviews

TUBA can put breast implants under the muscle through the belly button


TUBA (transumbilical breast aumentation) places breast implants through a tunnel from your belly button to the breast.  It can place the implants on top of the muscle, or with more difficulty, under the muscle.  I learned TUBA from the developer of the procedure, Dr Gerald Johnson.  I did numerous cases and can make the following generalizations.  Bleeding and positioning aren't usually problems,  There are size limitations with submuscular implants.  Certain body types of patients can be very challenging to dissect. 

While I think it is amazing that the implants can be placed in this fashion, I generally prefer axillary placement of the implants.

Daryl K. Hoffman, MD
Los Gatos Plastic Surgeon
4.5 out of 5 stars 10 reviews

Under or over

Yes, you can have the implants placed over or under the muscle as long as the surgeon who is performing your surgery is experienced in the technique.

Michael Constantin Gartner, DO
Paramus Plastic Surgeon
4.5 out of 5 stars 60 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.