Breast augmentation pertains to placing an implant beneath or above the breast tissue or chest muscle. It is one of the most common procedures performed by cosmetic surgeons.
There are four techniques used to do breast augmentation operations and they are named depending on where the surgeon makes the access incision:
-Transaxillary - In the underarm area
-Periareolar - Around the nipple
-Inframammary - Through the breast folds
-Transumbilical - Around the belly button
The inframmary crease approach is the most popular of the four. Transumbilical is the least used of the techniques because of the remote access for doctors. Breast augmentation via the transumbilical approach is simply known as TUBA (TransUmbilical Breast Augmentation).
The main reason a patient wants to undergo TUBA is because of the scarring. In TUBA, the patient will not have a bad scar as seen in the other three techniques. The surgeon places the incision far from the breast tissue so there will be no obvious scarring in the chest area. TUBA starts with the creation of a half circle incision around the belly button. The next step is to make space for the implant by inserting an instrument that can expand the breast pocket. Once there is enough space, a long blunt instrument will be inserted to place the implant in the breast area.
The other breast augmentation techniques increase a patient’s risk for a complication known as synmastia (where the breasts come together at the center of the chest). This occurs when the surgeon dissects too close to the ribcage causing the breast tissue to pull away from it. If the surgeon dissects too low, the fold of the breast will be violated resulting in the implant sitting too low and the nipple lifted too high. If the surgeon goes too far to the side, the implant then goes near the armpit. This can all be prevented by performing TUBA wherein the incision is done remotely.
With the transumbilical technique, putting the implant under the muscle can be a bit of a challenge. Placing the implant below the muscle is considered the standard of care because it significantly lowers the incidence of capsular contracture. Plus, placing more tissue over the implants means it will look more natural.
There is also a chance that using the transumbilical method can injure the ribcage. Why? The instruments that the surgeon uses to move up the implants knock up against the ribs producing excruciating pain for the patient. Aside from the extreme pain, there is also a risk of puncturing the chest cavity. Furthermore, patients who have had transumbilical breast augmentation are more likely to request revisions particularly if the implant was just placed under the breast. Most surgeons tell their patients that the implants were planted under muscle when in reality they just put it under the breast. The bottom line is it is very difficult to get that implant under the muscle using the transumbilical technique.
Another limitation with TUBA is that it limits the patient’s options to saline implants only. Silicone implants are prefilled and the surgeon cannot get these through the small incision in the belly button. Saline implants can be put in the body in its deflated form. The surgeon will fill them up once they are properly positioned in the breast pocket.
One of the most dreaded complications of breast enhancement procedures in general is capsular contracture wherein scar tissue forms around the implants. Capsular contracture occurs when there is too much bleeding and bruising on the breast area. To reduce a patient’s chance of suffering from this complication, the surgeon must perform precise pocket dissection using electrocautery. Remember with TUBA the surgeon is working blindly so anything that can reduce bleeding as much as possible like electrocautery is helpful in preventing this complication.
Another complication associated with any kind of surgical operation is bleeding. In TUBA, there will be some bleeding underneath the chest muscle and more bleeding if the implant is put on top of the muscle. Since the transumbilical technique is sort of a blind procedure, the surgeon cannot completely see the bleeding nor control it effectively.
Other complications from the procedure include numbness which can occur as a result of injury to the abdominal wall or to the organs under the muscle where the implant will be placed.
Implants that have ruptured must be removed from the body as soon as possible. According to patients who have experienced ruptures as well as the subsequent removal of the implants, the procedure can be extremely painful. Most would rather have a new, less painful regular incision to get rid of the ruptured implants.
The majority of patients experience soreness within the first 24 hours. There will be some abdominal pain as a result of the blunt dissection. Most surgeons agree that recovery is significantly longer and more painful with the transumbilical technique.
The first results of TransUmbilical Breast Augmentation are going to be visible immediately because the surgeon is placing an implant. However, it takes time for the implants to completely settle in place. In general, no matter what breast augmentation technique was done, patients are looking at a couple of months before the final results can be seen. Patients should consult with an experienced and skilled doctor in order to determine which breast augmentation procedure is the best choice for their situation.
Written by Cosmetic Town Editorial Team- AA
Based on an exclusive interview with Dr. John Burns in Dallas, TX