Transumbilical Breast Augmentation

By Dennis Hurwitz on October 23, 2006

For many women, breast size and shape are important parts of feeling desirable and confident. Breast augmentation can improve self-esteem, and today it remains one of the most frequently performed aesthetic procedures in the United States. Traditionally, breast implants have been inserted through incisions on or near the breast—either around the nipple-areola complex, within the inframammary fold, or through the armpit.

Now, with the use of endoscopic technology, implants can be inserted through the belly button, leaving no scars on the breast or surrounding skin. Transumbilical Breast Augmentation (TUBA) or Endoscopic Breast Augmentation (EBAM) is a scarless breast augmentation technique pioneered by Dr. Gerald Johnson in 1991. The method was first developed by placing implants through an abdominoplasty incision. Dr. Johnson realized that he could use an endoscope, or lighted camera, to tunnel through the fat and reach the breast area from a small incision inside the navel.

In addition to eliminating scars on or near the breasts, this method allows both implants to be placed through a single incision. Our Pittsburgh plastic surgery center is now the only practice in the city that offers the TUBA procedure, giving patients access to minimally invasive augmentation.

Advantages of the TUBA Procedure

• A single inconspicuous scar deep within the navel
• Less invasive and thus less breast trauma
• Minimal bleeding
• Faster recovery
• Less risk of injury to the sensory nerves of the nipple and breast
• Shorter operative time
• Less anesthesia

Misconceptions about TUBA

Common misconceptions about Transumbilical Breast Augmentation persist, but many were clarified in the American Society of Plastic Surgeons’ Journal (Volume 106, Number 1, July 2000). Below are the most frequent myths and their clarifications:

1. Dissection of the implant pocket is too difficult from a remote location. The pocket is created by expansion, not sharp dissection.
2. The rate of TUBA complications is higher than other approaches. In trained hands, the complication rate is one-eighth that of regular breast augmentation.
3. Bleeding cannot be controlled from a remote position. Bleeding is sparse with the TUBA procedure, with rates under 0.5 percent in published articles.
4. Implant positioning cannot be properly controlled. During the expansion phase, the surgeon can modify the final shape of the breasts and implant position.
5. Navel rings preclude the TUBA procedure. The ring is removed prior to surgery and reinserted afterward.
6. Implants are pushed through an endotube and easily damaged. Implants do not contact instruments; they are guided along the tunnel by external pressure.
7. Visible abdominal track deformities are common. No instances were noted in the cited ASPS journal publication.
8. Using the implant as an expander damages it. A separate expander performs the tissue dissection.
9. Implant warranties are voided because of TUBA. This is untrue.
10. The TUBA procedure is a blind technique. An endoscope confirms tunnel and pocket dissection as well as implant placement.
11. Only subglandular placement is possible. Both subglandular and subpectoral TUBA procedures can be performed.
12. Implants cannot be removed through a TUBA incision. They can be removed or exchanged through the umbilical incision without secondary incisions.
13. Pain occurs in the abdominal muscles from trauma or disruption. The abdominal muscles are not disrupted; surgery is performed in the subcutaneous plane, leading to less discomfort and faster recovery.
14. Patients with an umbilical hernia cannot undergo TUBA. The procedure can provide an excellent opportunity to repair an appropriate umbilical hernia.
15. The implant plane cannot be controlled. The endoscope verifies where the pocket sits relative to the pectoralis muscle.
16. An incision on the breast is required to insert a drain. Surgeons rarely need drains, but if used, small tubes can exit via the navel.
17. The surgeon can perforate organs or lungs during the procedure. Instruments are not sharp enough, and tunnels are created through fat beneath the skin, away from organs.
18. TUBA is impossible after other abdominal operations. Old abdominal scars can be used as alternative entry sites.