Transumbilical Vs Conventional Breast Augmentation

Question

What is the difference between transumbilical Breast augmentation and conventional Breast augmentation?

Edwin C. Pound, III, MD · Answer

There are four basic incision sites: in the crease under the breast, under the areola, in the armpit, and in the belly button.  There are pros and cons to each of them which you should discuss in detail with your doctor.  I have done over 5000 TUBA procedures, above and below the chest muscle, over the past twenty years.  I consider the following to be the pros and cons of this approach:

	Pros:

	1. There is only a single small scar hidden under the upper fold of the belly button.  Since many surgeries are done through such an incision, it is not a scar that is likely to be associated with breast augmentation.

	2. Implants can be placed above or below the chest muscle.

	3. There is little cutting of tissue involved with this surgery.  I don't even hook up a cautery when I use this approach because there is basically no bleeding involved.  Because there is little cutting of tissue, there is less risk to the sensory nerves to the breast and nipple, less risk of bleeding, and faster recovery time.

	 

	Cons:

	1. Only saline implants can be used with this approach.

	2. Because the incision site is more remote from the breast, there is a greater chance of asymmetry with this approach.  It is best to use a doctor with a lot of experience with this approach to minimize this risk.

	3. Future surgeries may require using a different incision site.

	4. Rarely, a "knot" or a "cord" may be felt along the abdominal tunnel.  In my experience, this always goes away with warm compresses and massages.  I have NEVER seen a permanent one.

	As with any procedure, it is best to use a doctor with a lot of experience with this technique and who is certified by the American Board of Plastic Surgery.  There are many doctors out there who take weekend courses and then proclaim themselves plastic surgeons.  This has been especially true with the TUBA procedure.  Beware!

Richard Zienowicz, MD · Answer

It does not make sense to put scar tissue on a breast. Armpit incision is a wonderful scar-free option for breast augmentation. Silicone implants can absolutely be inserted through the arm-pit, don't let anyone tell you that is not an option. There are few reasons for an incision under the breast or through the nipple. The scarring under the armpit is minimal, look at the attached video. Don't let doctors not comfortable with the approach talk you out of it. Transaxillary is the standard in Asia and the UK and the results are completely natural. Patients are so happy not having to deal with any types of incision or scarring on the breast.

Michael Constantin Gartner, DO · Answer

TUBA is not a technique that most surgeons perform because it requires special training and higher skill. However, I have performed TUBA for years. It is safe and actually involves a shorter recovery period than other breast augmentation techniques.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.

Jerome Edelstein, MD · Answer

I am unsure of what you mean by conventional breast augmentation. Do you mean incisions placed in the inframmary, periareolar and transaxillary position vs transumbilical approach? 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.

Armando Soto, MD, FACS · Answer

Hi there-
Placement of breast implants via an incision around your belly button, in the TUBA technique is, in my opinion, a poorly conceived operation you would be better off avoiding.
To understand why, it's best to get a firm perspective.... I think it would be safe to assume that your interest in breast augmentation is the result of your desire for a breast shape and size that is as beautiful as possible, yes?
The reality is that attempting to place implants through a peripheral location like your belly button causes a significant compromise in the possible outcome of your breast surgery- it's simply not possible to perform delicate maneuvers for the manipulation of breast shape when trying to do so from far away by feel, rather than under direct vision in proximity to the area.
If you were going to do something delicate, wouldn't you want to be able to see what you were doing clearly and be close to what you were doing??
I do a great many breast enhancement procedures a year, but wouldn't do this operation again for anything-
Remember- the goal is to have beautiful breasts, NOT to be able to say you had implants placed through your belly button.

Otto Joseph Placik, MD · Answer

I am not a proponent of the TUBA as I have seen at least 10 patients with complications due to uneven placement of the implants with this procedure.
I would generally advise you to avoid the use of this technique. Many of the other excellent physicians around here seem to agree as well. What does that tell you? Why would they not perform the procedure if it had a high satisfaction rate?

George Marosan, MD · Answer

TUBA or transumbilical breast augmentation is an acceptable technique to augment the breasts. A very small number of surgeons use this and market it as not leaving a scar on the breasts. The breast scars are 3-4cm (11/4-11/2in) and placed that when healed, the untrained eye would not see them. The TUBA surgeons do not advertise the negative sides to the procedure (hopefully these are discussed with you in the consultation). First of all, it can be used with saline implants only, the implant manufacturers do not warranty the implants placed in this fashion, if you have a bleed or problems with placement, position or capsular contracture, it might be difficult to address these issue via the umbilical incision again.

Charles K. Lee, MD, FACS · Answer

Transumbilical augmentation has been popularized by the idea that the scar and incision is placed in the belly button area and therefore "hidden" from the breast area.  Only saline implants can be placed with this method as the "track" from the belly button to the breast has to accomodate a small object (the folded implant)  that is then expanded.   I have seen some very nice results from this technique, but I have seen some disasters.
First, the belly button is not the "cleanest" area on the body to place an incision and also place a sterile implant through.  I have seen some very large scars in this area and the possibility of infection is higher.
Second, the creation of a submuscular pocket --the most important part of placing an implant--is not done in an ideal environment, given the distance of the belly button to the breast area.  Again, given the distance, the silicone gel implant (with the most natural feel and appearance) cannot be placed through this incision.
Standard incisions (nipple or inframmary--at the breast crease), allow full access to the breast area for pocket creation, whether below or above the muscle.  You can have silicone gel implants or saline implants.  The scars area well tolerated, and can really be quite hidden.  This is my recommended approach for breast augmentation and most board certified plastic surgeons would likely agree this statement.
The other incison, armpit or axillary, is also a possible approach.  Saline and gel implants can be placed, but the maximal gel implant that can be safely placed is around 250cc.  250cc is on the smaller end of the normal request for augmentation and so, most of my patients who have inquired about this approach opt out.  They usually want 325-400cc.
So remember, certain approaches like the "TUBA" may sound great, but there are limitations when incisions get further and further away from the actual site of surgery.

John J. Edney, MD · Answer

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.Other more conventional types of breast augmentation such as through the crease at the bottom of the breast or through an incision at the border of the areola allow for more precise development of the pocket, less chance of bleeding problems after surgery, and less need for future revisional procedures.

Jon F. Harrell, DO, FACS · Answer

After reviewing the answers to this question I thought I would offer an alternative viewpoint. In my practice I have performed breast augmentation through every approach, periareolar, perithelial, inframammary, axillary and transumbilical. The transumbilical approach has virtually eliminated the axillary approach in my practice. It is true that the transumbilical approach has a significant disadvantage in that one cannot place silicone implants using this small incision and revisional surgery may not be possible through the umbilical incision. It's not clear to me how many of the responding physicians have experience with this approach but after performing hundreds of breast augmentations with this technique I can categorically state that the result should be every bit as good as when using a more common breast incision. However, for the surgeon, this approach requires giving up direct visualization of the implant pocket and may create the feeling that the control of pocket creation or blood loss is going to be a problem. I know - I shared those concerns before I actually performed the technique. However, these were concerns that never materialized. To be sure there is a 'learning curve' for the surgeon and this isn't a technique one can teach himself. However it is in my opinion a valuable technique for the woman who does not want an incision on her breast. Instead of talking these patients out of what they want I now am able to satisfy their desires to avoid breast scarring. The worst revisional breast augmentation cases I have ever seen were surgeries that were performed through 'convention' incisions. I think bad results are possible regardless of the incisional approach. If you are really serious about a transumbilical approach see a doctor who is experienced in this approach and make a decision. Best of Luck Dr Harrell

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