The TransUmbilical Breast Augmentation (TUBA) procedure was developed in the early nineties as an alternative method of placing breast implants that would leave no visible scar on or around the breast. Building on his experience of placing breast implants through abdominoplasty or tummy tuck incisions, Dr. Gerald Johnson, realized that he could use an endoscope, or the lighted tube used in other types of limited access surgeries, to tunnel just underneath the skin up to the breast area from a small incision hidden in the upper fold of the belly button. Besides eliminating scars on or near the breasts, this method allowed both breast implants to be placed through a single incision. Initially, TransUmbilical Breast Augmentation (TUBA) breast implants were only placed under the breast tissue, above the chest muscle. As others gained experience with the TUBA procedure, surgeons realized that the implants could also be placed under the chest muscle, a modification, which is sometimes desirable in women who are thin with little breast tissue present to cover the implant. The TUBA procedure is performed under general anesthesia similar to that used in liposuction surgery. A small incision is made in the fold of skin, which overlies the belly button (navel), so the scar will not be visible. A blunt instrument called an obturator is used to gently tunnel under the skin to the level of the breast crease. If the implant is to be placed under the breast tissue, the dissection is performed on top of the muscle in the loose connective tissue plane between the muscle and the breast tissue. If the implant is to be placed in the plane below the muscle then the dissection is carried out in the loose connective tissue plane under the chest muscle. The endoscope is inserted to confirm the correct plane of dissection. This is followed by a breast implant sizer, which is rolled into a taco shaped roll and guided up the tunnel into the pocket created. The implant sizer is then inflated with sterile normal saline solution (physiologic salt water) to a size somewhat larger than the final implant to be placed, to allow for refinement of the dissection. The same TUBA procedure is then completed on the opposite breast, and any asymmetries are noted. The sizers are then deflated and removed. The final implants are placed in a similar fashion. The small tubes, which will allow them to be filled with normal saline, are left exiting from the navel from their respective tunnels. Small adjustments may now be performed by equalizing the breast size as much as practical by varying the amount of saline placed in each implant. The fill tube is then pulled gently out of the self-sealing valve of each implant and the valve covers seat over the valves to ensure closure. The single belly button incision is then closed with sutures, which the body will dissolve, and a light compression dressing is placed. The average recovery time for return to normal daily activities after Trans Umbilical Breast Augmentation (TUBA) is 2-7 days for implants placed over the muscle and is 4-7 days for implants placed under the muscle. Total healing, as with all surgeries, will take six to twelve months. The patient may return to normal exercise in two to three weeks. TransUmbilical Breast Augmentation Risks Saline breast implants have a proven safety record, however, as with all breast implants, they are not permanent. Eventually the implant wall or valve will fatigue, and the implant will leak. Since they are filled with sterile saline, which is similar to the body’s own natural fluid, the saline will be harmlessly reabsorbed by the body. All breast implant manufacturers currently warranty their implants for life, and will replace any deflated implant that fails from normal wear and tear. If an implant fails within ten years of the initial surgery, the implant manufacturer that I use will pay $1200 (or $2400 if additional coverage is purchased for $100) towards the cost of the replacement surgery. It is possible to replace the implant through the Trans Umbilical approach. Specific risks of Trans Umbilical Breast Augmentation (TUBA) breast implant surgery should be discussed in detail with your surgeon during a thorough consultation.