Why I Don’t Do Trans-Umbilical Breast Augmentation (TUBA)

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One of the questions I get from time to time when I am talking about breast enlargement with patients, is whether or not I do this through the belly button (this is known as the “TUBA” or Trans-Umbilical Breast Augmentation). In fact, one of the reasons I am writing about this is because one of our fans asked about it on our facebook page. And, not to give away the ending to this blog, let me say at the outset that I do not, and I don’t recommend it. Here’s why:

About “TUBA”
First, as they say, a little background. This technique has been developed within the last twenty years. There are a few surgeons who have championed this technique, but they seem to be pretty much in the minority. Presumably the raison d’etre for the operation is to perform breast augmentation with less noticeable scars. As I look over the articles written about TUBA I am struck by two things. First, many of these articles are written to justify the safety of the operation. Well, if trans-umbilical breast augmentation is truly safe and effective, you don’t need an article to tell you this. My second observation is that there are not many photographs of the belly button, and even fewer comparing its pre- and post-operative appearance.

A Little Common Sense
My bias against this begins with a little common sense. Does it really make sense to operate on the breast from an incision so remote? Would you operate on a wrist through the elbow? (It’s about the same distance.) I don’t think so.

Technically Speaking
But let’s get a little more technical. Over the past ten years or so, we have learned a lot about how to get the best, most natural, and softest results from breast augmentation. These involve controlling even the smallest amout of bleeding, precise dissection of the pocket into which the implant will be placed (with as little tissue trauma as possible), and using silicone implants (where appropriate). Begin with the last, you can’t place a silicone implant through the belly button. And if you some reason you did, the manufacturer’s warranty on the implant would be voided, because you probably injured the implant when you placed it.

The pocket in this operation is dissected without direct vision (blindly), and done bluntly. To put a finer edge on this, a blunt dissector (i.e., tool) is forced up and into the breast to make this pocket. This means that you have less control over the dimensions of the pocket, and thus less precision in implant placement. And believe me, this is critical. Also, you can’t control any blood vessels that you cut (and they are there, I see them every time I do a breast enlargement). This bleeding can lead to an increase in scar tissue around the implant and thus a more unnatural result.

What About The Scar?
But, if were really going to talk turkey, let’s talk about the scar. There will always be one. And more times than not, it will deform the belly button to a degree. Perhaps in some this is small, but in others it could be significant. And, some surgeons make the scar at least three quarters of the way around the belly button, if not all the way around. Incisions on the breast, either in the natural crease beneath, or at the edge of the areola, are covered by bathing suit tops (and the silicone sheeting we use after surgery really helps to minimize them). But the only bathing suit that will cover a TUBA scar is a one-piece. So, you tell me: in real life, which scar is most visible?

The Bottom Line
So, for any of you who have wondered about a trans-umbilical approach, here’s my take on it. If you are thinking about breast augmentation, don’t contemplate your navel. (I know, I really shouldn’t have but……………..)

All the best,

David B.

By the way, if you are looking for information on breast augmentation, be sure to check our our new eBook “A Girlfriend’s Guide to Breast Augmentation”.

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Knoxville Plastic Surgeon