Trans-umbilical breast augmentation
You're right. The TUBA procedure remains controversial and is not offered by most plastic surgeons. 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 is not a technique that most surgeons perform because it requires special training. However, I have performed TUBA for years. It is safe and actually involves a shorter recovery period than other breast augmentation techniques.
Do your research and find out more about your surgeon if you don't feel comfortable about him.
Trust your instinct
It is best to go with your instinct. Your doctor may be in fact the "best at tuba" but the method is not popular due to its difficulties in achieving satisfying results.
However, please note that there are possible complications and risks associated with all breast augmentation methods. The most common complications to consider with the TUBA approach are inaccurate implant placement, the ability to only have saline implants, and the placement of incisions in another site if revision surgery is necessary.
Is TUBA a Good Choice?
I wouldn't say it's "extremely odd" for a doctor to recommend a TUBA
procedure. If you have not discussed every aspect of breast
augmentation in terms of your overall goals, however, then I might say
that recommending transumbilical breast augmentation seems premature.
Your plastic surgeon needs to evaluate your physique and understand what
you're hoping to achieve, then talk with you about the best way to get
there. This includes the type of implant (silicone vs. saline), size
and placement. Incision options are secondary to these key decisions.
There are not many plastic surgeons who perform the TUBA procedure.
That doesn't mean you can't get a good result with TUBA, but I would
make sure your doctor does lots of these surgeries and that the
constraints TUBA places on the other aspects of breast augmentation are
ok with you.
you make your final decisions, I would advise you to consult at least
one other board certified plastic surgeon and go in with a clean slate.
Start with your goals and see what he or she recommends.
Elliot Jacobs, M.D.
New York Plastic Surgeon
While it is true that not many plastic surgeons perform the TUBA, there are plastic surgeons who have been properly trained and have developed expertise in this operation. I have many satisfied TUBA patients. However, since the silicone implants have become so popular, the demand for the TUBA has diminished because the TUBA can only be performed with saline implants. It is important that the operation is appropriate for each patient and that the surgeon does not try to have all patients have the same operation. If you have an interest in silicone implants, the TUBA is not for you. Also, if you have a low degree of body fat, silicone implants may be better for you.
Doctors are like cooks. They all have their own technique(recipe) for surgery. If you are comfortable with surgeon and like his results you should be fine. Complications may occur with any approach. Good luck. Donald R. Nunn MD Atlanta Plastic Surgeon
If you have concerns, get second opinion
You should trust your surgeon and be comfortable about his/her recommendations. If your have concerns, get second opinion.
TUBA breast augmentation
To answer your question it is not odd to offer TUBA breast augmentation to the right patient. In appropriate candidates for saline breast augmentation, the TUBA procedure actually is a very good option as there aren't any visible scars. You should go to an in person consultation and then base your decision upon the results shown to you of other patients that had the TUBA procedure. I would caution you to be wary of anyone touting themselves as being the best in any one particular procedure. I perform more than 50 TUBA procedures per year which may be the highest in the NY area.
Breast Augmentation Question
In general, tuba procedures involve saline implants above the muscle. Is this want you want? I tend to use an inframammary (in the breast crease) incision or a periareolar (around the areola) incision and normally place the implant in a subpectoral (below the muscle) pocket.
How can you make up your mind with a phone call. Very few doctors do that procedure for various reasons, in general , a more standard approach gives a better result with a better implant. Get some in person consultations with a local plastic surgeon.