Transumbilical Breast Augmentation (TUBA) Overview
Senior Medical Editor
Many women want to avoid even the smallest possibility that scars from their breast augmentation will show. Inserting breast implants through the navel can eliminate visible scars common with traditional breast implant incisions. But, there are many differing opinions on how well TUBA (transumbilical breast augmentation) works.
Many cosmetic plastic surgeons do not think well of it, while others think it is an excellent option. The American Society of Plastic Surgeons (ASPS) does not keep track of how many surgeons perform TUBA or how many breast augmentations are done using any given type of incision.
Richard V. Dowden, MD, FACS, says that the opinion of surgeons about TUBA depends on whether or not they use the technique. “The ones who love it are the ones who are trained to do it and have done it. The ones who hate it are the ones who are not trained to do it,” he said.
The number of plastic surgeons using a transumbilical approach is growing, but slowly, says Dr. Dowden, who is in private practice in Cleveland and who has performed about 1200 TUBA procedures since 1992. “I think it is increasingly popular,” he says. He knows of about 60 cosmetic plastic surgeons who perform TUBA, of whom 30 are board-certified.
Keith Berman, MD, a plastic surgeon in practice in New York City, sets the percentage of plastic surgeons who offer the technique at about 2%. Although he does not use the TUBA approach, he does about 300 breast augmentations each year.
The most commonly used incision areas for breast augmentation surgery are around the nipple (periareolar), in the armpit (transaxillary), and in the crease under the breast (inframammary). These are tried and true locations for incisions, but can leave visible scars on the breasts that some women feel are unacceptable. But all three can be used for either saline-filled or silicone gel-filled implants, Dr. Berman noted. With saline implants, incisions can be only an inch long, he added.
Dr. Berman noted that because you are working at a distance from where the breast implants will be placed, it is harder to get symmetry in the placement. “Symmetry is one of main goals of breast augmentation and the further away from the target area, the harder it is to get symmetrical.”
Breast implants inserted through the navel have a tendency to be too high, in his experience, said Dr. Berman. TUBA placement also takes longer than the more widely used incisions, he added
Both Drs. Berman and Dowden are certified by the American Board of Plastic Surgery. Dr. Dowden is also a Fellow of the American College of Surgeons.
In TUBA, the surgeon uses a device called an endotube to make two tunnels under the skin of the abdomen from the navel to the spots where the breast implants will go. The surgeon then inserts tissue expanders and inflates them to create the pockets, which can be either over the chest muscles or under. After the pockets are created, empty breast implants are put into place and inflated with saline.
Dr. Dowden says that the only contraindication to a TUBA approach would be a large hernia on the upper abdomen.
Officially, both Allergan and Mentor Corporation, the makers of the only approved saline breast implants, do not recommend a transumbilical placement. However, such placement does not void any implant warranties, Dr. Dowden said, which the manufacturers confirmed. Recommendation of a transumbilical placement would require a change in the labeling for implants, something that the U.S. Food and Drug Administration would have to approve, he said. Cosmetic plastic surgeons are allowed to insert breast implants any way they see fit, which includes transumbilically.
