TUBA (TransUmbilical Breast Augmentation): Not My Favorite

By Stuart Linder, M.D., F.A.C.S. © 2008

I'm sure there are many satisfied patients who have augmented their breasts with the TUBA procedure.

But before telling you more about my experience, let me explain what the TUBA is and what it purports to do.

TUBA (it stands for TransUmbilical Breast Augmentation) is a way to augment the breasts by inserting rolled-up implants from a small incision in the patient's navel and then placing them under her breasts. Once the implants are in place, they are filled with saline; the filling tube is then removed and the small naval incision sutured.

It may sound good and appear often in the popular press, but I see the procedure from a completely different perspective.

Of the 82 or 83 breast implant procedures I perform monthly, I usually see two or three unhappy TUBA patients on a continuing basis.

Breast Implant Revisions

Those patients come to me because, in most cases, their implants sit too high on the chest or there is so much space between the breasts that no cleavage is apparent. At any rate, those patients want a more natural-looking bosom and ask me to perform a breast revision after their TUBA procedure. (Read more about badly placed breast implants.)

When I'm faced with these patients, I often explain by analogy and say, "If you were a golfer, would you rather attempt a two-foot putt or a ten-foot putt?"

Breast Augmentation

My personal favorite technique for breast augmentation is to make an incision in the peri-areolar, or brown, area surrounding the nipple. I'm virtually on top of the area where the implant is to be positioned. Thus, I can see everything clearly and can more easily manipulate the delicate tissues and muscle structures inside and under the breasts at the chest wall.

From my standpoint, I see that many TUBA procedures turn out less than perfect because the surgeon must work so far away from the target area. Most TUBA surgeons see what they are doing by inserting a tiny, lighted camera under the skin at the navel and then creating a tunnel just under the skin to each breast. Perhaps the surgeon can see with the lighted instrument somewhat but he or she can't use the sense of touch.

Natural-Looking Bustline

I can't stress enough that those very delicate muscle attachments at the base of the breasts must be expertly handled if the procedure is going to produce a natural-looking bust line. And I don't see how anybody can do that from so far away.

Above everything else, we plastic surgeons place patient safety foremost among our concerns. So I'm in a good position to know that inserting a long tool at the navel and then working it up under the skin to the breast is too far a distance to be accurate 100 percent of the time.

In addition, the chances of penetrating a vital organ along the way are too great. And that could be tragic. Complications can also develop in those tunnels.

Scars

One of the basic reasons for performing a TUBA is because the only resulting scar is hidden within the folds of the naval. But the resulting scars on a patient's peri-areolar areas are not that objectionable. When the incision is placed along the areola border, patients usually find the resulting scars to not be visible at all once healed. Additionally, those incisions cause hardly any complications.

I see the TUBA method as unwise and unwarranted because I consider it less safe, more fraught with possible complications and -- judging by the unhappy patients I see --- less able to achieve natural, perfect breast symmetry.