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 37

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.


Atlanta Plastic Surgeon
4.8 out of 5 stars 24 reviews

Breast Augmentation through the belly button is not popular for good reasons

The reason why few surgeons would offer this procedure is that it is nothing more than a gimmick!
It provides the surgeon with a very limited option of saline only implants, minimal to no control over the pocket creation for the implants (the pockets are created "blind'), high complication rates, and serious lack of consistency in results achieved. The only "benefit" of this procedure is a scar in the belly button. However, if the results are poor and largely unpredictable, then the scar is irrelevant.

One of the basic variables in augmentation surgery is where the scar is going to be. The important thing to understand is that their will always be a scar. The surgeons job is to ensure you achieve the best quality scar in the least visible location. Also, the surgeon should not compromise technical "perfection" by choosing a scar location that provides less control over what is being done internally to create the implant pocket and insert the implant. This is the problem with the belly button approach - the surgeon is compromising the quality of the surgery and results for the sake of a "trendy" scar.

Of course, like most things in surgery you will find differing opinions over what is the "best" approach.

With implant placement, only 3 incisions/scars are "commonly" used: armpit; lower areolar border; lower breast fold. 

Each approach has advantages and disadvantages.
- Via the areolar is simply not possible when the areolar diameter is too small and therefore you are unable to pass an implant through a small access hole. Also, should the person scar badly it's not a great spot to have a bad scar - although this could be argued for all techniques.
- Via the armpit approach can scar nicely, with no scar associated with the entire breast mound. However, these can scar badly and therefore can never be hidden! A bikini/bra will cover any scar on the breast mound (areolar or lower breast fold). Also, the armpit approach means that the surgeon has the least control and is furthest removed from the areas that he/she needs most control in creating the pocket - the cleavage region. In addition to this, should the patient require any further surgery then it is general not possible to re-use these scars, so the surgeon needs to create another scar (such as in the lower breast fold).
- The lower breast fold incision is by far the most popular approach employed by plastic surgeons, and it is how I do the vast majority of my cases. The scar sits neatly within the lower breast fold crease. This approach provides the surgeon with the best control and management of the entire implant pocket and insertion/positioning of the implant. This scar can also be easily re-used should further surgery be required for whatever reason.

Furthermore, many would consider that the areolar and armpit approach can result in potential "contamination" of the implant as these areas have a higher bacterial load than the lower breast fold region. Whilst this would logically be correct I'm not entirely convinced it is clinically true and/or relevant. However, its another acceptable argument for not routinely using these approaches.

Eddy Dona, MBBS, FRACS
Sydney Plastic Surgeon
4.9 out of 5 stars 64 reviews

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
4.8 out of 5 stars 108 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.

TUBA

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
4.7 out of 5 stars 29 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. 

TUBA

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.

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.