Common misconceptions about transumbilical breast augmentation (TUBA)?
The most common myths concerning transumbilical breast augmentation were
summarized and dispelled in an article published in the official journal
of the American Society of Plastic Surgery* as paraphrased below:
It is too difficult to dissect all the way up there.
The pocket is created not by dissection, but by expansion. There is no
cutting behind or in the breast. Pocket creation is actually
easier than using any other method.
There are too many complications.
The original study showed a
lower complication rate than with other methods. There is also less bleeding
compared to other methods.
The surgeon cannot control bleeding.
There is a remarkable absence of bleeding with TUBA and
rarely any bleeding at all to control. However, doing so presents no problem by visualizing the implant pocket
through an endoscope.
The surgeon cannot position the implants properly.
Because the surgeon sees the exact shape of the breast and position of
the implant during the expansion phase,
there is no guesswork in implant positioning.
Pushing implants through the tube damages them.
Implants are not pushed through a tube. The implant is seated on the end
of a tube used to push implants into position.
The technique leads to visible track deformities on the abdomen.
The author saw no visible track deformity in seven years performing TUBA.
Using the implant as an expander can damage the implant.
This is the most understandable of the misconceptions. Originally, the
implant itself was used as an expander, putting it under excessive stress.
This has not been done since 1992. Instead, a separate expander step has been incorporated into the technique.
Using the transumbilical technique will void the warranty on the implant.
This is patently untrue.
We have verified with implant manufacturers that this technique does not
void the warranty.
It is a blind technique.
This has no significance in actual practice. Tissue expansion, rhinoplasty
and liposuction are all "blind" techniques that are well-accepted, performed
frequently and have low complication rates. Moreover, the transumbilical
technique is the only one of these "blind" approaches in which the operative site is
inspected with an endoscope, so is not truly blind.
The technique increases the risk of implant failure.
untrue in both practice and theory.
The technique is only suitable for prepectoral placement.
This was initially true. However, instrumentation and techniques for subpectoral
placement have been available for some time.
Removal of the implant cannot be done through a transumbilical incision.
The saline implants are
easily removed through the navel.
Disrupting the abdominal muscles causes excessive pain.
Abdominal muscles are not disrupted in any way. The entire procedure is performed above the anterior rectus
fascia in the subcutaneous plane. One noteworthy feature of the transumbilical
procedure is that it is less painful than other methods and results in
The technique cannot be performed if the patient has an umbilical hernia.
The original article cited "abdominal hernia" as a possible contraindication
to transumbilical augmentation. In fact,
an umbilical hernia can be repaired at the same time.
The implant must pass between the abdominal organs.
The transumbilical procedure is
entirely subcutaneous and does not involve abdominal organs or muscles.
The technique cannot be performed if the patient has a navel ring.
Navel rings have proven no obstacle. Some surgeons prefer the ring to be removed during the procedure and reinserted
afterward; others prefer to leave them in place or even use them to aid
Going through the navel will cause infections.
No surgical procedure can be free of the possibility of infection. The
author has seen no infections with the transumbilical procedure; but has
seen them with other methods of augmentation.
Infection is very unlikely. With the incision so remote from the implant, even a wound infection would
be unlikely to reach the implant.
The surgeon cannot control the plane of the implants.
The endoscope is used to
verify that the implant is in the proper plane relative to the pectoralis muscle.
Using a drain would require a breast incision anyway.
Most surgeons performing transumbilical augmentations have not used drains.
Thin, round drains may be used through the navel and so no breast scarring.
At Bozeman Health Cosmetic Surgery,
we have rarely found drains to be necessary.
*Dowden, R. V. Dispelling the Myths and Misconceptions about Transumbilical
Breast Augmentation. Plastic & Reconstructive Surgery. Volume 106(1),
July 2000, pp 190-194