Common Myths About Breast Augmentation through the Belly Button (T.U.B.A.)

Common misconceptions about the Trans-Umbilical Breast Augmentation (T.U.B.A.) exist, and incorrect information may be given to patients seeking advice. This incorrect information can be given even by some of the finest plastic surgeons. In the American Society of Plastic Surgeons' Journal publication Volume 106, Number 1, July 2000, Dr. Richard Dowden published an article titled 'Dispelling the Myths and Misconceptions about Transumbilical Breast Augmentation'. Dr. Dowden, a respected member of the American Society of Plastic Surgeons, recognizes that most plastic surgeons are not knowledgeable about the T.U.B.A. procedure, yet these plastic surgeons remain vocal about their criticism about the T.U.B.A. procedure, despite never having trained, studied, or performed the method themselves -therefore, these surgeons' qualifications to comment on the T.U.B.A. procedure should be questionable. Dr. Dowden addresses 20 commonly heard misconceptions (among plastic surgeons) about the T.U.B.A. as follows -these are not direct quotes from the publication in the Journal of Plastic and Reconstructive Surgery, only summation:

1. Dissection of the breast implant pocket is too difficult from such a remote location
The pocket is created by expansion, not actual sharp dissection. No cutting takes place for the dissection of the implant pocket either behind or within the breast.

2. Too many complications exist with the T.U.B.A. procedure
Dr. Johnson's original publication actually showed a lower rate of complications than other methods, and that has been Dr. Dowden's experience with the T.U.B.A. method as well.

3. Bleeding cannot be controlled by the surgeon
One of the remarkable characteristics of the T.U.B.A. procedure is the absence of bleeding. Rarely is there any bleeding to control, but doing so presents no problem. Dr. Dowden reports using a cautery to control bleeding only one time in 350 T.U.B.A. procedures.

4. Positioning of the implants cannot be properly performed by the surgeon
When the expansion phase is taking place (tissue dissection by tissue expander), the surgeon can see the shape and position - there is no guesswork. "What you see is what you get".

5. Since the implants are pushed through an endotube, they can be easily damaged
Even the original article never described pushing the implants through the endotube, and it is not a required step to place the implants in the pocket behind the breast.

6. Visible track deformities on the abdomen
Dr. Dowden reports no instances of visible track deformity on the abdomen as a result of the T.U.B.A. procedure in his 7 years of performing this procedure.

7. Since the implant is used as an expander, it becomes damaged
The original article by Dr. Johnson shows the step of using the implant as an expander, however use of the implant as an expander has not been done since 1992. A separate expander is now used to perform the tissue dissection.

8. Warranty is voided on the implants because of the T.U.B.A. procedure
This is untrue. There are some manufacturer's representatives that are unaware of this fact, and they help to perpetuate this issue.

9. The T.U.B.A. procedure is a blind technique
Procedures such as liposuction, certain steps in a rhinoplasty, as well as tissue expansion are all blind techniques that are commonly practiced and well-accepted. The fact that an endoscope is used during the T.U.B.A. procedure renders the statement "blind" untrue.

10. The risk of implant failure increases with the T.U.B.A. procedure
The origin of this misconception is not readily verifiable, but possibly related to the early publication of the use of the implant as a tissue expander. Originally, McGhan style 60 implants , which had a higher incidence of faulty valves, were used.

11. Prepectoral (Sub-Glandular) placement is the only option using the T.U.B.A. procedure
While initially true, the T.U.B.A. procedure has been performed with sub-muscular placement for some time now.

12. Implants cannot be removed through a T.U.B.A. (umbilical) incision
Saline implants are, in fact, easily removed via an umbilical incision. Dr. Dowden reports having had occasion to remove implants to change size with no secondary incision being needed.

13. Pain occurs in the abdominal muscles as a result of the disruption
The abdominal muscles are not disrupted. The procedure is performed above the abdominal muscles in the subcutaneous plane. Overall, the T.U.B.A. procedure is less painful than other procedures for breast augmentation, and results in a more rapid recovery for the patient.

14. If the patient has an umbilical hernia, the T.U.B.A. procedure cannot be performed
This is an understandable misconception, however the T.U.B.A. procedure offers an excellent opportunity to repair an umbilical hernia. Dr. Dowden reports having done so in several cases.

15. The implant passes through the abdominal cavity (organs)
A board-certified plastic surgeon actually made this ridiculous comment! The T.U.B.A. procedure takes place below the skin and above the abdominal muscles. The abdominal cavity and organs are in no way involved.

16. If a patient has a navel ring, T.U.B.A. cannot be performed
Obviously, this was also speculation by someone unfamiliar with the T.U.B.A. procedure. Some surgeons leave the ring in during the procedure, others prefer to remove the ring and re-insert the ring after the procedure.

17. Infection will occur as a result of going through the navel
Dr. Dowden reports seeing no cases of infection as a result of the T.U.B.A. procedure. Dr. Dowden does report having seen infections with other breast augmentation procedures (methods). Since the incision for the T.U.B.A. is so far away from the implant, even if the wound were to become infected, the infection is not likely to reach the implant.

18. The plane of the implant placement cannot be controlled by the surgeon
The reason an endoscope is used is to verify where the implant pocket is positioned, relative to the pectoralis muscle. Dr. Dowden reports no instances of having an incorrect implant placement.

19. An incision on the breast would be required to insert a drain
Surgeons performing T.U.B.A. typically do not use drains, however if on the side of caution a surgeon chooses to insert a drain(s), the small, thin tubes lead out via the navel incision and no scar on the breast is required.

20. This T.U.B.A. technique is just a temporary gimmick
There is no reason for the demand for this technique to disappear - only time will tell. Women see a friend's rapid recovery and inconspicuous scar and will inquire. Some women have, in fact, rejected breast augmentation until learning that the procedure could be performed through the belly button.

Other names for this procedure include:TUBA, belly-button breast augmentation, band-aid breast augmentation, scarless breast augmentation, naval breast augmentation, transumbilical breast augmentation, belly button breast surgery, band aid breast surgery, scarless breast surgery, transumbilical breast surgery, naval breast surgery.

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