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Key iconKey Points

  • Transumbilical breast augmentation (TUBA) is an appealing alternative for some women because it results in an inconspicuous scar
  • Surgeons performing TUBA say concerns about the procedure are unfounded when performed by well-trained hands

Dr. Mendieta
COCONUT GROVE, FLA. — Even given the recent cosmetic availability of next-generation silicone breast implants, there remains abiding interest in the nearly scarless advantage presented by the transumbilical breast augmentation (TUBA). Though not without its controversy, plastic surgeons offering this procedure tell Cosmetic Surgery Times that it represents an important option when performed in properly selected patients and by surgeons who are adequately trained.

SALINE AND SCARLESS A key characteristic of TUBA is that it can only be performed using saline-filled implants, although implant placement via this route can be either above or below the pectoralis muscle. Its advantages, proponents claim, include lower risks of surgical complications such as hematoma and infection, as well as an easier recovery relative to the alternative approaches to breast augmentation. Those differences are modest, however, compared to TUBA's major advantage: it results in a nearly invisible scar.

"It's always valuable to have alternatives to offer cosmetic surgery patients because individuals vary in their interests and concerns. Since TUBA is performed through an inconspicuously placed incision in the navel, it can be very appealing to women who are concerned about having a visible scar in the breast region," says Constantino G. Mendieta, M.D., F.A.C.S. Dr. Mendieta is a board-certified plastic surgeon practicing in Coconut Grove, Fla., who has been performing TUBA for seven years.

Richard V. Dowden, M.D., C.M., F.A.C.S., a board-certified plastic surgeon in private practice in Mayfield Heights, Ohio, first learned the TUBA procedure in 1992. He says it can offer the same outcomes as breast augmentation surgery using the inframammary, transaxillary or periareolar routes. Therefore, the primary consideration in selecting TUBA as the approach becomes patient preference for scar location.

"TUBA definitely results in a less visible scar, and I have encountered patients who rejected breast augmentation until they learned of this alternative. On the other hand, there are some women who feel uncomfortable about having their navel touched at all and are especially squeamish about having an incision there. The bottom line is that there are benefits and trade-offs for all approaches to breast augmentation, and choosing between them is usually a decision each patient has to individualize for herself," Dr. Dowden says.

INVESTMENTS IN TOOLS AND TRAINING Both surgeons also agree, however, that good results with TUBA depend upon surgical expertise. "TUBA is definitely a fairly complex technique. Underlining that concept is the fact that textbook chapters I have written on TUBA run 20 to 30 pages in length. Therefore, my primary recommendation for surgeons who are interested in developing this skill is to take a formal training course and acquire hands-on experience," Dr. Dowden recommends.

(left) 28-year-old, 5-foot 10-inch tall patient, shown pre-operatively, was a B-cup size and wanted a D size. (right) Same patient shown 7 months post-operatively following subglandular placement above the pectoralis muscle of 650 cc-sized smooth round saline implants inflated to 650 cc on both sides.
Dr. Mendieta agrees. "Acquiring the skills needed to perform TUBA and achieve consistently predictable results requires formal training. The procedure also requires the availability of additional specialized instruments, which makes it a little more expensive than other approaches," he adds.

IDEAL CANDIDATES Dr. Mendieta points out that patient selection is another critical determinant of a good cosmetic outcome. Though he notes that surgeons who perform TUBA will have their own criteria for appropriate candidates, in his own practice, Dr. Mendieta excludes women who have significant asymmetry, deformities or ptosis.

"Working through the navel allows breast augmentation, but not a breast lift or other more extensive modifications. Therefore, the TUBA candidate should have well-shaped breasts to begin with," he explains.

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