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Key Points
- TUBA is an endoscopic technique that involves placing breast implants via a single 3 cm incision created within the superior lip of the umbilicus
- TUBA provides an opportunity for surgeons to perform several simultaneous cosmetic procedures through the navel
- TUBA and mastopexy surgery are often coupled together to improve nipple areolar complex ptosis and asymmetry
Cosmetic surgeons who already perform cosmetic breast enhancement procedures should learn the transumbilical approach because it is faster and safer relative to all other saline augmentation techniques, says Robert A. Shumway, M.D., F.A.C.S., of Shumway Cosmetic Surgery, La Jolla, Calif. Dr. Shumway is a past-president of the American Society of Cosmetic Breast Surgery (ASCBS), the immediate past-president of the California Academy of Cosmetic Surgery (CACS) and a trustee of the American Board of Cosmetic Surgery (ABCS) and the American Academy of Cosmetic Surgery (AACS).
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The TUBA tissue expander. (Photos credit: Robert Shumway, M.D., F.A.C.S.)
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TUBA HISTORY, TECHNIQUE Transumbilical breast augmentation (TUBA) is a special endoscopic technique developed by Gerald Johnson, M.D., in 1991. It involves placing breast implants via a single 3 cm incision created within the superior lip of the umbilicus. Dr. Shumway performs the TUBA technique, but he also created the modified TUBA (called the transabdominal breast augmentation, or TABA) for patients with pre-existing abdominal scars. Either way, the implantation can be performed within a prepectoral or a subpectoral position via tumescent anesthesia and IV conscious sedation, he says.
"After learning from an experienced TUBA surgeon, the new surgeon should tackle the 'easy' cases first. Patient selection is the key for any novice TUBA doctor, i.e., choose reasonable patients who are not obese, possess fairly symmetrical breasts, have realistic expectations and are seeking an appropriate augmentation size," Dr. Shumway says.
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TUBA implant introduction.
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"The first 10 TUBA surgeries must be successful, or else the developing physician will desert the procedure," he says. "However, most well-trained aesthetic breast surgeons will find TUBA much like sliced bread ... yes, it's a magnificent idea that makes each one of us wonder why we didn't think of this sooner! Just remember to pick your slam-dunks first, so that you will not become discouraged and prematurely abandon the procedure."
Dr. Shumway says TUBA is faster and safer because the thorax is approached superficially in a tangential fashion with blunt dissection via one small, distant incision that is located in a universal scar — the navel. The risk of pneumothorax, internal organ injury, hematoma and scarring are diminished compared to other breast augmentation routes that utilize a perpendicular approach to the chest wall or cutting instruments and electrocauterization.
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TUBA fill tubes.
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In addition, chemical vasoconstriction from the epinephrine-containing tumescent solution, along with the hemostatic nature of tissue expander usage, further reduces the risk of bleeding and subsequent scar formation, he says.
TUBA also provides an opportunity for cosmetic surgeons to perform several simultaneous cosmetic procedures through the navel. For example, the cosmetic appearance of the navel can be improved with concurrent umbilicoplasty. And TUBA and mastopexy surgery are often coupled together to improve nipple areolar complex (NAC) ptosis and asymmetry. The Benelli, crescent or vertical mastopexy may be performed directly after TUBA without violating fat or breast parenchyma, Dr. Shumway says.
