TUBA Breast Augmentation

I want to do a Transumbilical (TUBA) Breast augmentation. Can use you TUBA procedure to put the implants under the muscle?

Doctor Answers 55

Umbilical Breast Augmentation Great Method in Experienced Hands

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Yes, you can place saline implants with an umbilcal approach under the muscle. And yes, the placement can be done accurately. The vase majority of doctors who claim that you cannot have accurate placement have not even done one breast augmentation with the umbilcal technique. So of course if you don't have experience it would be difficult. All the methods are good for placing breast implants including umbilical and trans- axillary. But if your doctor gives you a million reasons why the areola is better or the crease that probably means he/ she prefers to do it that way. So if you go to that doctor that is the way you should do it. Going with the umbilcal technique does not void the warranty.

Beverly Hills Plastic Surgeon
4.6 out of 5 stars 106 reviews

TUBA's attraction is no scar on the breasts. But a bad augmentation looks worse than no scar!

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It should be clear from (most of) my colleagues' comments that TUBA is fraught with potential problems that usually occur more frequently than with other incision choices. I know well-trained, experienced, board-certified plastic surgeons who do this operation (TUBA), and do it well. But just because it is possible does not mean it is the best!

The surgeons who promote this operation can show you many patient photos that will impress you, making you think that perhaps this is indeed a good choice. For a select few of these surgeons experienced in this technique, it can be.

But most plastic surgeons can do the same (lots of great photos) with the other incision choices. But if you asked for the complication rate, re-operation rate, or satisfaction rate for several hundred consecutive patients of each technique, TUBA will have higher dissatisfaction, complications, and re-operations, in my humble opinion, than the other three incision choices.

I believe a carefully and precisely closed incision with fine sutures and below-the-skin closure results in an almost invisible scar in the vast majority of patients. I prefer the incision that allows me to do the most careful pocket creation, control bleeding and resultant pain, bruising, and capsular contracture, and the most accurate implant positioning. This allows the least complications, the fewest re-operations for any reason, and then the scar becomes a truly insignificant concern (even for models and entertainers)!

BTW, TUBA patients who require re-operation for virtually any reason require a scar on the breast (the very thing you were trying to avoid in the first place). Best wishes! Dr. Tholen

Richard H. Tholen, MD, FACS
Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

Yes to Subpectoral

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Breast implants can be placed under the pectoralis muscle via the umbilical incision (TUBA).  However, there are limitations to the TUBA approach.  Because the incision size is small and located in a remote position, saline implants must be used, you cannot use silicone, it just won't fit.  If you are very thin the path (tracts) from the umbilicus to the breast used to place the implants can develop noticeable scarring.  Also, if you need to have your inframammary crease adjusted during the procedure, which is very common, it is hard, but not impossible to perform through the belly button.

I have been using the TUBA and TABA (trans-abdominal bilateral augmentation) for 10 years and it is a valuable procedure in the RIGHT  patient.  

Good Luck,

David R Finkle, MD

David Finkle, MD
Omaha Plastic Surgeon
4.9 out of 5 stars 82 reviews

With difficulty and only with saline

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In my practice, I had the opportunity to operate at the same surgery center with Gerald Johnson,the plastic surgeon who developed TUBA ,and scrubbed with him on a few cases. The technique is primarily limited to sub mammary placement of saline implants. I never saw Gerald place the implants under the muscle. Although there are a few physician who describe sub muscular placement using the TUBA approach, I see more patients with malposition of the implants using this technique, than I have seen patients with a nice result. For sub muscular placement, I use either the axillary, periareolar, or inframmary crease incision. If you're going with saline, the incision is only 3 or 4 cm which is about 1 1/2 inches. With silicone the incision is larger since silicone implants are prefilled.

Joseph M. Perlman, MD
Houston Plastic Surgeon
4.3 out of 5 stars 27 reviews

Under or over

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Yes, you can have the implants placed over or under the muscle as long as the surgeon who is performing your surgery is experienced in the technique.

Myths about TUBA dispelled

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TUBA is a great operation for sub-muscular placement of saline implants in anatomically appropriate patients.  It does have a steep learning curve and should not be universally used for all augmentation patients, any more than a transax (armpit), periareolar,  or crease incision.  Thin patients with good symmetry (yes, they exist) and no sagging are the best candidates.  There are risks, as with any proceedure, but in the hands of an experienced surgeon, the results are excellent, reproducible, with very little down time and no tracking on the abdominal wall, even in the thin patient.  All this with a virtually "scarless" procedure.  Do your research and find a plastic surgeon in your area that has a lot of experience and, provided you're an appropriate candidate, you should have a very nice result.  If you can't find a sureon in your area, travel to a place where there is one.  It will be worth the effort!CS chris@heddenmd.com

Christopher J. Schaffer, MD
Birmingham Plastic Surgeon

The TUBA procedure is a good operation

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I have been doing the Trans-Umbilical Breast Augmentation (TUBA) for almost twenty years now and approximately 4000 patients from all over the world.  I have a LOT of experience with this approach.  It can be done with the implants placed above or below the chest muscle.  The benefits of the TUBA approach is that there is only a single small scar hidden within the belly button.  Also, since there is less cutting of the tissue, the recovery seems to be faster and there is less risk to the nerve that supplies sensation to the nipple.  The disadvantages of the TUBA procedure are:  1.  It can only be used with saline-filled implants.  2.  Because the incision site is farther away from the breast, there is less precision in making the pocket and therefore a greater risk of asymmetry.  Be sure to choose someone with experience to do this procedure.  Even though I have done probably more TUBA operations than anyone else, I still get occasional patients that I need to take back for some asymmetry issue.  3.  If there are any problems during the initial surgery or if there is a need for a future surgery, a standard incision on the breast may be required.  For deflations, I can simply go back up through the navel and retrieve and replace the broken implant.

I think the TUBA has gotten a bad rap over the years.  I think this is primarily because there are a lot of non-board-certified plastic surgeons who do this operation and do it badly.  It is important that you find someone who is properly qualified to do this operation, not someone who simply took a weekend course somewhere.  In my experience, most plastic surgeons who say bad things about the TUBA have either never done one or never seen one done.  Those  plastic surgeons who have come to watch me do this operation have left the O.R. shaking their heads at how easy this operation is to do.

Edwin C. Pound, III, MD
Atlanta Plastic Surgeon
4.6 out of 5 stars 26 reviews

TUBA - Can it be done under the muscle?

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In a word - yes! In fact, I think the surgery is technically easier to perform under the muscle than trying to insert the implant on top of the muscle. Another point I would make is don't be discouraged and keep looking for someone who has experience with this approach. There are a lot of 'theoretical' objections to this procedure, but for the right patient it  is a great technique. There is only one small and inconspicuous incision and results should be comparable to all other techniques. Still, there is a definite 'learning curve' for the surgeon and he/she has to leave the comfort zone of being able to look directly at the operative site. Silicone implants cannot be used with this technique and it can be difficult to perform revisional surgeries through the same incision as well. Still if you want saline implants, don't want an incision on your breasts and if your umbilicus is large enough this is, in my opinion a worthwhile procedure - with the understanding that you are using a board certified plastic surgeon with experience in this approach.


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Implants placed by the TUBA procedure can be placed under or over the muscle, but are typically placed over the muscle.  I have seen many patients with bad results after this procedure including implant malposition or implants just too tight in the pocket.  In general, the only advantage is the scar.  Often, using this procedure will void the warranty for your implant so I would definitely consider your alternatives. Scott Newman, MD FACS

Scott E. Newman, MD, FACS
New York Plastic Surgeon
4.9 out of 5 stars 42 reviews

Reconsider TUBA

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TUBA (Trans-Umbilical Breast Augmentation) is not embraced by most plastic surgeons because there are specific additional risks unique to this approach, including improper implant positioning, either soon after surgery or developing over time.

Before committing to this approach, consult a few plastic surgeons or read more about the complications on the Internet.

Paul C. Zwiebel, MD
Denver Plastic Surgeon
4.7 out of 5 stars 45 reviews

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.