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 36

Breast Augmentation through the belly button

When it comes to options for incision, the periareolar, trans axillary (armpit), and inframammary fold are the most common approaches. Typically, the approach depends on the desire of the patient balanced with the individual's particular anatomy. For instance, a periareolar approach can be a poor choice when this area is too small. The transaxillary approach is typically done with the assistance of an endoscope while the surgeon observes the progress on a monitor. Any approach has its merits and should be decided upon after a dialogue between patient and surgeon.

Trans-Umbilical Breast Augmentation

Insertion 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.

As a plastic surgeon I understand the appeal of minimizing visible scarring.

My 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 my patients.

John Diaz, MD
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 34 reviews

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.

John J. Edney, MD
Omaha Plastic Surgeon
5.0 out of 5 stars 99 reviews

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. 


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
5.0 out of 5 stars 114 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.  

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.