Revisiting the Trans-Umbilical Breast Augmentation (TUBA) Procedure
Win Pound, M.D.
There are essentially four incision sites used for the insertion of breast implants – the incision under the breast (inframammary), under the areola (infra-areolar), the armpit (trans-axillary), and the belly button (TUBA). Through each of these incisions, breast implants can be placed above or below the chest muscle. The only incision site through which silicone gel breast implants can NOT be placed is the TUBA approach. This technique is strictly limited to the use of saline breast implants due to the fact that they must be inserted unfilled and then filled once they are in position behind the breast.
The TUBA approach enjoyed a great deal of popularity during the fourteen years that silicone gel breast implants were removed from the market from 1992-2006. When silicone gel implants were returned, most patients and plastic surgeons preferred to use them because of their more natural feel and approximation to real breast tissue. Still, there were some distinct advantages to using saline-filled breast implants with the TUBA approach:
The TUBA approach requires only a single incision located inside the belly button, which is essentially a scar itself. The resulting scar is well hidden and no one associates an incision in the belly button with breast implants.
There is less cutting of tissues using the TUBA approach and therefore less discomfort following the surgery.
If a saline implant develops a leak, it is obvious within a few days and the implant can be replaced using the TUBA approach. Also, the saline is simply absorbed by the body. Current silicone gel implants use cohesive silicone gel. A ruptured silicone gel implant may be difficult to detect.
The volume in saline implants can be adjusted during surgery. Saline can be added or removed to compensate for small asymmetries between breasts. Silicone gel implants come pre-filled and cannot be adjusted.
Saline-filled implants are much less expensive than silicone gel implants. For patients trying to conserve money during tight economic times, saline implants are a good way to save money without compromising the final results.
Don’t get me wrong. I love silicone gel implants and use them a lot. I just think that saline implants in general and the TUBA procedure in particular have been under-appreciated over the years. In the right hands with the right patient, they can produce results that are as good as those with silicone gel.