Category Archives: Breast Augmentation

Breast Enlargement/Breast Augmentation – the most popular procedure today in Atlanta

Breasts are an important symbol of femininity for women. Advancement in medical science has now given us the freedom to bring changes in how we look. We no longer have to accept the bodies we were born with. Now women who are not satisfied with their bodies especially breasts, have the option of breast augmentation, which is also known as breast enlargement.


From 1991 to 2003, the popularity of the procedure dropped due to concerns about the implants used during the surgery. Since then the science has advanced  and now the implants used are proved safe. The safer implants have led to the increase of the popularity of this procedure.


Breast enlargement is a surgical procedure performed under anesthesia. The aim of the procedure is to increase the size of the breasts. Surgeons may use general anesthesia, or local anesthesia combined with a sedative.  In this procedure, implants made from artificial materials are surgically inserted for the purpose of enlarging a woman’s chest. The procedure can correct the chest of different sizes, restore shape and reconstruct it following a mastectomy.

Is the surgery risky?

  • Occasionally implants rupture and need to be replaced
  • Implants do not last forever and, therefore, you need to discuss with the plastic surgeon if and when the implant has to be replaced.
  • Your breast will feel numb for some time after the surgery
  • You may get an infection around the implants

Post Surgery

  • You need someone to take you home from the hospital.
  • You need someone to be there with you all the time.
  • You can’t lift heavy weights.
  • You may also need antibiotics and pain medication for a few days.
  • Need to rest for a week or so.

Before the surgery, it is advisable to visit a reputable and qualified doctor. A reliable plastic surgeon helps you achieve the desired results.

TUBA- A specialized breast augmentation procedure

Breast Augmentation is one of the most popular surgeries today. Stats say that more women have undergone this surgery than any other cosmetic surgery. Breast Augmentation process lets you choose desired shape and size of the implant, but when it comes to its methods, there are many of them used today. One of the newest and quickest techniques is the TUBA Technique.

TUBA stands for trans-umbilical breast augmentation. The procedure was developed in 1991 and became popular for placing breast implants that would leave no visible scar in or around the breast. These implants are placed through a hole in the belly button. It is an endoscopic procedure, where in a small camera is inserted in the body, to capture images from inside. These images help the doctors perform the surgery.

The procedure involves the insertion of the endoscope through the incision made in the belly button. The endoscope is pushed upward to create a tunnel to insert the implant into its place. After this, the surgeon makes a pocket in the area to fit the implant. A tiny roll of unfilled saline implant is pushed through the incision to the breast pocket. Once it is in its correct position, it is filled with saline. Now the implant is sealed, and the pocket is repositioned, and the incision is closed.

Procedure takes 30 to 45 minutes to complete. After the surgery, the patient is suggested to rest for a week or so. Some can observe pain, swelling, and bruising. These symptoms subsidize as time passes. The doctor may also prescribe you some medicines for pain and other discomforts. Few scars can be visible under the skin for few days, but they will go with time.

Benefits and risks

  • No visible scars
  • Less painful
  • Low cost procedure


The procedure is not permanent. The implant wall will weaken and leak in few years.  The implants used are filled with sterile saline, which is similar to the body’s own fluid. The leaked saline will be reabsorbed by the body.

TUBA is a more specialized breast augmentation technique, but before this you need to consult several plastic surgeons in your area before you find the one who performs this procedure.

Breast Augmentation Choices

Incision Sites, Positioning, and Making the Right Decisions for Your Body

Breast augmentation, statistically, has been one of the most requested cosmetic surgeries in plastic surgery for many years. Women who seek breast augmentation generally fall into one of the following categories:

  • Women who have never had much breast tissue and want to fit clothing better or to feel more feminine.
  • Women who have lost volume during a pregnancy.
  • Women who have a developmental asymmetry of the breasts.
  • Women who have breast asymmetry from previous surgery.

A breast implant is simply intended to add volume to the existing breast tissue. It is NOT designed to change the basic shape of the breast or to lift the breast itself. If a breast lift is the goal then a different procedure would be necessary. In addition, a breast augmentation procedure will not give a patient more cleavage. Cleavage is determined by the width of the chest bone. Attempts to decrease this width and provide the patient with more cleavage may end badly. While a breast augmentation may add more volume to the breast itself, a push-up or push-in type bra is more advisable for creating cleavage. The breast is generally fully developed by the time the patient is eighteen years old. Patients under this age should be discouraged from seeking a breast augmentation. The breast may continue to change over the life span of the patient as a result of weight gain/loss, pregnancy, periods, etc. Breast implants are also not guaranteed to last a lifetime. Additional surgery may be required at some point to replace the implants or to improve the shape of the breast itself as it changes with time. Breast augmentation surgery can be performed through one of four possible incision sites: a single incision in the navel, incisions under the fold of the breast, incisions under the areolae, or incisions in the armpits. The advantages and disadvantages of each incision site are as follows:Trans-Umbilical Breast Augmentation (TUBA):

  • The incision site is hidden within the belly button.
  • Recovery is fastest with this approach.
  • There is less cutting involved and therefore less risk to the breast tissue or to the sensory nerve to the nipple.
  • Implants can be placed above or below the chest muscle via this approach.
  • Only saline implants can be used with this approach.
  • Precise development of the implant pocket is more difficult with this approach so that the risk of asymmetry may be higher.
  • Future surgeries may require a different incision site.


  • The incisions are located in the natural folds under the breasts.
  • This is the easiest approach from the surgeon’s standpoint.
  • Implants can be placed above or below the chest muscle.
  • Saline or silicone gel implants may be used.
  • An underwire bra may rub and irritate the incision scar in this location.
  • If the patient wears a small bathing suit top and lifts her arms up, the incision scar may be exposed.


  • The incisions are located under the areola on each breast.
  • Saline or silicone gel implants may be used.
  • Implants can be placed above or below the chest muscle.
  • The change between the color and texture of the skin and areola helps hide the scar.


  • The incisions are located in the armpits.
  • Implants can be placed above or below the chest muscle.
  • Saline or silicone gel implants may be used.
  • There is less precision in development of the breast implant pocket and a greater risk of asymmetry.
  • If incisions do not heal well, they may be noticeable when the patient wears something sleeveless.
  • If the incisions do not heal well, they may interfere with shaving the armpit.

Additional potential complications associated with breast augmentation with any of the above incision sites may include:

  • Loss of sensation to the nipple or breast. The sensory nerves to the nipple/breast come from between the ribs. The risk of numbness or even super sensitivity is in the range of 2 – 10% of patients. Of these, statistically, 85% of patients will recover normal sensation within a year. Permanent losses are rare.
  • Capsular contracture. Patients are not born with implants. Since the body cannot reject the implants outright, it simply seals them off by forming a capsule made out of scar tissue around the implant. This is a normal occurrence. As long as the capsule remains thin, the patient should not notice it. If the capsule becomes thickened or tightens down, then the patient may require additional treatment to correct the situation.
  • Bleeding or infection. Fortunately, these are VERY rare occurrences, but may require additional treatment.
  • Breast feeding. While their breast tissue may change with a pregnancy, patients should be able to breast feed no matter which incision site is used.
  • Mammograms. Most mammographers have been dealing with breast implants for fifty years now. Mammograms are performed slightly differently for patients with breast implants than for patients who do not have them in order to visualize all of the breast tissue adequately. There is some suggestion in the literature that mammograms are easier to perform and interpret when the implants are placed under, rather than over, the chest muscle. In addition to the incision site, patients must also decide whether to place the implants above or below the chest muscle.

Advantages and disadvantages of each position include: Above the chest muscle:

  • This is where the breast tissue is located and therefore where the implant will behave most like breast tissue.
  • There is a higher risk of capsular contracture when the implant is located above the chest muscle. This may be due to increased bacteria in the breast tissue (and therefore increased risk of a subclinical infection) or the loss of the massaging action of the chest muscle gliding over the breast implant.
  • There is a greater incidence of rippling/wrinkling of the implant above the chest muscle.
  • Recovery is faster and less painful.

Below the chest muscle:

  • There is a decreased risk of capsular contracture since the muscle slides over the implant massaging it as the patient goes through her normal activities.
  • There is less chance of seeing/feeling ripples/wrinkles as the muscle adds another layer of coverage over the implants.
  • Flexing the chest muscle may cause the implants to move in an unnatural fashion. Over time, this may also cause the implants to migrate towards the armpits.
  • Muscle does not stretch as easily as breast tissue. It may take a longer time for the breast to drop and soften than it would if the implant were located above the chest muscle.
  • Recovery may be more uncomfortable due to the tension in the muscle.
  • If the breast tissue itself tends to sag over time, the implants may remain higher on the chest wall and not descend with the breast tissue.

Breast augmentation surgery is usually done under general anesthesia in an outpatient setting. Bandages are generally removed within a day or two. Some doctors use drains. These would also be removed in a few days at most. Patients recover at different rates but should expect discomfort for four to five days. Patients may resume non-strenuous activities when they feel like it. More strenuous activities should be avoided for at least three weeks following the surgery. Breast augmentation surgery can make a great difference in a patient’s self-image. In order to achieve the best possible outcome, the patient should seek out a plastic surgeon certified by the American Board of Plastic Surgery (ABPS), the only board recognized by the American Medical Association for the training and certification of plastic surgeons. The doctor should be willing to spend time with the patient answering any questions that she might have. She may also want to look at before/after pictures or talk with a previous patient about her experience. Breast augmentation surgery is a life changing event. It is important for a patient to do her research thoroughly with regard to the type of implant to be used, the incision site, and also the credentials and experience of the doctor performing the surgery. Dr. Win Pound is an expert in many areas of plastic surgery and is a world renowned expert in trans-umbilical breast augmentation (TUBA). Dr. Pound has performed the TUBA breast augmentation procedure more than any other plastic surgeon in the world. Contact his office for more information or to request a free consultation.

TransUmbilical Breast Augmentation

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.