Breast Augmentation Through the Belly Button?

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.

This is a good question as the majority of patient that wish
to have a breast augmentation desire a result that is going to feel and look
natural without having obvious scars.



There are several ways to place the incision so that it is
well hidden in natural skin folds or breast transitions.

1.Periareolara.Hidden at the natural transition from the areola
and the breast skin. The incision can be
hidden in this natural color transition



2.Inframmary Fold a.The incision is hidden in the fold below the
breast.



3.Axillaa.The incision for the implant can be hidden in
one of the natural axilla folds.



4.Umbilicala.This technique has become less popular as only
saline implants can be place using this method.
b.Also patients run the risk of destroying the
fold, which can cause their implant to drop overtime.







It is important to see your board certified
plastic surgeon to help guide you to an implant that will give you an
aesthetically pleasing breast.

Thank you for your question. The TUBA method has fallen out of favor for a few reasons. The surgeon can only use a saline implant; she/he has very little control of the breast pocket; and it's difficult to make fine-tuning adjustments after the implant has been inserted. In addition, scars for traditional incision placements are very well hidden. Take a look at my Guide to Breast Augmentation web reference below for more information and an in depth look at the various other choices that should be considered for breast augmentation.

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.

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.

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.   

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.

         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.  

It's a blind procedure with little control of your breast pocket.  You are limited to saline implants with this option.  There's a reason none of the surgeons you have seen recommend it.

Best,