Experience With Transumbilical Breast Augmentation (TUBA)

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Experience With Transumbilical Breast Augmentation (TUBA)

By: Laura Sudarsky, M.D.

Transumbilical breast augmentation (TUBA), an endoscopic-assisted procedure in which saline breast prostheses are inserted through the umbilicus, is a patient-driven, frequently performed procedure that remains controversial. The author describes the operative technique and results in 90 patients who underwent TUBA between October 1996 and July 2000 by the same surgeon in a community practice. A total of 85 patients underwent submammary TUBA and 5 patients underwent submuscular TUBA. Seventy patients were available for follow-up. Postoperative results of the 70 patients were graded as very good in 56 (80%), good in 12 (17%), and fair in 2 (2.9%). Complications were conversion to an open approach in 1 patient and an accidental submuscular entry into the pocket in 1 patient. There were four capsular contractures (5.7%), 5 patients (7.1%) were reoperated: 2 for capsulectomies, 1 for implant buckling, 1 for scar revision, and 1 for removal of the implants. There were no implant ruptures, hematomas, or infections. Advantages of TUBA include minimal scarring, remote incision, short operating time, low capsular contracture rate, and rapid recovery. These results of this evolving procedure suggest that in select patients TUBA provides a high level of patient satisfaction and low complication rates. As TUBA techniques for submuscular placement continue to develop, more patients may become TUBA candidates.

Sudarsky L. Experience with transumbilical breast augmentation. Ann Plastic Surgery 2001;46:467—473

From the Plastic Surgery Division, Good Samaritan Hospital, Suffern, NY. Received Dec 4, 2000, and in revised form Dec 15, 2000. Accepted for publication Dec 15, 2000.

Address correspondence and reprint requests to Dr Sudarsky, Highmount Medical Building, 311 North Midland Avenue, Upper Nyack, NY 10960.

Transumbilical breast augmentation (TUBA) is an endoscopic-assisted procedure in which saline breast prostheses are inserted through the umbilicus. Originally described by Johnson and Christ1 in 1993, TUBA has become a patient- driven, frequently performed procedure. This procedure, however, has engendered some controversy among plastic surgeons concerning the involved difficulties and complications. Technical modifications have been reported by Vila— Rovira2, and a submuscular approach has been used successfully. From October 1, 1996, to July 1, 2000, a total of 90 patients underwent TUBA performed by the same surgeon in a community practice. As of September 2000, 70 patients were available for follow-up. The goal of this study was to present the aesthetic and surgical outcomes in these 70 patients.

Materials and Methods

All patients had Mentor (Santa Barbara, CA) smooth, round mammary prostheses (style 1400 or 1600 series), inflated between 200 and 475 ml. An extralong fill tube is used for the 1600 series. A nonmedical observer graded aesthetic outcome based on patient interview and pre- and postoperative photos. Patient results were graded as 1, 2, 3, or 4 (poor, fair, good, or very good). Preoperative assessment included a mammogram (if the patient was older than 30 years), breast exam, sternal notch-to-nipple measurement, nipple-to inframammary fold measurement, and history. Patients were also evaluated postoperatively for capsular contracture, infection, hematoma, reoperation, and deflation.

Operative Technique

In the holding area, risks, benefits, and alternatives are discussed further with the patient, especially the fact that if a technical problem occurs, the procedure will be converted to an open approach. The patient then chooses the i