TUBA (Transumbilical Breast Augmentation)

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9. I have my navel pierced, will I need to remove it before surgery? Will I have to let it close up afterwards?

You are usually allowed to keep a simple, stainless steel navel ring (captive bead) or barbell intact before surgery. Although you will need to scrub the area gently, but thoroughly, the night before surgery with an antibacterial soap to lessen the chance of infection. During your surgery prep your surgeon will also sterilize this area. However, if this is a newer piercing and there is an infection present (oozing or pus) you may be asked to remove it and let it heal before your surgery can be carried out.

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10. Is TUBA usually more expensive than traditional incision placements?

Although some surgeons like to tell you this, TUBA. actually takes less time (from 35 to 45 minutes with TUBA-experienced surgeons) and less surgical materials (sutures, surgical sponges, surgical tape, gauze) than traditional methods.

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11. If I have a rupture, can I have my implants replaced through the navel as well?

Absolutely! There is no reason to have additional scars for a simple ruptured saline implant replacement surgery. The incision will be made where your original incision was placed, the implant removed and replaced. In fact, the replacement operation usually involves less pain that the primary. This is due to the fact that most of the pain is due to the formation of the implant pocket and tissue expansion - this goes for both sub-glandular and sub-pectoral placement.

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12. Can I have a breast lift AND TUBA?

Unfortunately not. To lift the breasts there must be excess skin excision. Since there is no need for an additional scar in the navel when the breast lift incisions are large enough for implant placement. Your breast lift incisions, depending upon the technique which will be determined by the degree of ptosis (sag) and surgeon-technique, are more than enough room for sub-glandular and sub-pectoral implant placement (even crescent lift incisions are large enough).

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13. Can I get silicone gel or cohesive silicone gel implants with TUBA?

The silicone gel and cohesive silicone gel implants are pre-filled and must be implanted via the mammary fold or peri-areolar incisions. Imagine implanting an object the size of a large potato via your navel, hence the need for an infra-mammary or peri-areolar incision.

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14. I have heard the chance of infection is lessened with TUBA. Is this true?

Although there is always the chance of infection due to unforeseen problems such as improper wound care post-operatively, or the rare chance of bacteria on the surface of the breast implant, chances of infections are usually lessened due to the placement of the incision and the lack of implant-breast tissue exposure. The incision is not near the breast tissue nor is the breast implant is ever passed through the actual skin where staph naturally lives on the surface of our skin. Plus the ducts within the breast are never cut or disturbed which would release this bacteria nor is the implant passed through this ductwork where bacteria naturally lives. The implant is passed through an endotube which is inserted into your navel so that it has an untainted passageway into your body. If in the event that the incision site develops an infection, the tunnels created for insertion are usually closed or closing and the infection remains in the navel area.

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15. Why don't more surgeons perform TUBA?

Because either they have no desire to learn a new technique, they have heard the same fictitious things you have even heard and are researching on this page and believe it to be unbeneficial, they are not open to change, do not have time to learn a new technique or are simply not willing to adopt this new scarless technique.

Fortunately there is a rising trend in those who ARE learning this procedure and offering it to their patients.

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16. Someone told me that TUBA is not FDA -approved, is this true?

First off, the FDA does not approve actual breast surgery techniques. It approves medical devices, machines, medicines, dyes, preservatives, etc. If you are referring to when breast implant manufacturers were asked to present studies to the FDA proving their products safety and efficacy, the older techniques (infra-mammary, peri-areolar and trans-axillary) had enough cases with said prostheses to be recognized by the FDA during the approval of breast implants in 2000. The majority of the cases presented were of said techniques (infra-mammary, peri-areolar and trans-axillary) and were proven safe enough at that time of review.

Since TUBA (AND Trans-axillary) was a newer technique and did not have as many cases presented during the breast implant approval process, the FDA did not allow breast prosthesis manufacturers to place this technique's description in their presentations and product literature. This was considered a formality and even the breast implant prosthesis manufacturer considers the TUBA procedure safe and does not void the warranty because of its use.

Essentially this is a formality thought to mean that it is not allowed or approved and is dangerous, which is not the case. And just for garnish... saline breast implants were not approved until May of 2000 since being taken off the market many years ago. Incidentally, I got my implants before they were approved.

Bottom line, the FDA did not believe that enough evidence had been gathered to prove that silicone-filled breast implants met safety requirements but were allowed to continue clinical trials until future review.

If you would like more information please read below:

In Response To: FDA disapproves of TUBA (Elizabeth)

I have done over 1800 TUBA procedures (above and below the muscle) since early 1992. I say this to let you know that I have a vast experience with this procedure, probably more than anyone else in the country. I have seen the evolution of the TUBA procedure so I can tell you the FDA story.

When the FDA panel convened to decide on the safety and efficacy of saline-filled implants, there were two plastic surgeons represented on the board. The question regarding the TUBA procedure came up during the proceedings. Neither plastic surgeon had any experience with the TUBA procedure so they called the implant engineers to ask their opinion. These guys spend their lives in a back room designing implants so they had absolutely no experience with the TUBA either. Everyone had "heard bad things" about the TUBA but no one had actually seen it done. So instead of contacting someone like myself who actually had some useful information, they simply mandated, in an unprecedented move, that the implant manufacturers place a disclaimer in their literature about the TUBA. Just as with the silicone gel controversy in the '90's, their actions were based on politics, not science or experience. The implant companies love the TUBA (they even make my slides for my presentations) but they had no choice but to implement the FDA's mandate if they wanted to get their implants approved. Fortunately, I have heard rumors that the implant manufacturers may be allowed to change their literature soon so that this is not an issue.

The TUBA has been subject to an amazing amount of politics. It is a simple procedure and I get wonderful results with it. Nevertheless, I continue to hear the most ridiculous "bad things" from other plastic surgeons who have never seen the TUBA and don't offer it in their practice. They don't want to lose patients to someone who offers the TUBA procedure so they simply make up negative stories about it. While I don't mind people disagreeing with me, I think it is certainly incumbent upon a plastic surgeon who offers breast augmentation in his practice to speak from experience or not speak at all. Patients count on their doctors for information. If they don't have any experience with a procedure, they should simply note that and move on.

I think that one of the reasons that the TUBA is getting a bad rap is also the fact that, since the American Society of Plastic Surgery (ASPS) has tended to ignore it, the so-called cosmetic surgeons have jumped on it. These doctors come from many specialties and do not have adequate training or experience to be performing cosmetic surgery, but economic times dictate that they try. Because of their lack of adequate skills, they may get bad results. When they do, it is simply explained as a bad procedure or a plastic surgery disaster. No one seems to focus on the fact that the doctor doing the procedure has no business doing something he wasn't adequately trained to do.

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17. My surgeon told me that TUBA is dangerous and not a good procedure and that only uncertified surgeons perform it. Is this true?

This is not true. TUBA is performed, safely, by many surgeons who are and who are not certified by the American Board of Plastic Surgery. It is not a procedure of the rogues -- it is the procedure of the future. TUBA takes less operating room time, has less blood loss, less anesthesia needs, less intra-dermal cutting, less pain medications and less down time.

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18. I was told that TUBA can cause internal bleeding and that I can die from having an artery cut during this "blind" procedure. This scares me, is it true?

TUBA is not performed blind it is performed with more internal surveillance than open techniques due to the small camera used to help guide the surgeon during surgery. Nothing is cut after initial incision in the navel. All dissections are made bluntly disallowing sharp instruments to come into contact with the body - including arteries.