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Transumbilical Breast Augmentation (TUBA)
Houston, Texas Plastic Surgeon & Cosmetic Surgeon
Dr. Mark Schusterman
article courtesy Mark A. Schusterman, M.D., P.A.
CLICK HERE to visit the website of Mark A. Schusterman, M.D., P.A.
Transumbilical Breast Implant Procedure (TUBA)
Transumbilical Breast Augmentation, commonly known as TUBA or Endo Bam, is an endoscopic breast implantation procedure through the belly button (navel). The surgery is performed on an outpatient basis using general or local anesthesia.
TUBA has many advantages over other breast augmentation surgeries including a surgery time of about 30 to 45 minutes, resulting in reduced anesthesia, operating room time and recovery time.
Other Advantages of TUBA:
- Less invasive surgery
- Faster recovery
- Less risk of injury to the sensory nerves of the nipple and breast
- No obvious scars near the breast or armpits
- Less likely to produce infection
The TUBA Method
| 1. Prior to surgery, Dr. Schusterman will draw markings from the incision spot to the implant location. The markings will indicate where the tubing will be inserted under the skin as well as the dimensions for the implant pocket and the expansion of the breast. |  | 2. The surgical incision, made inside the navel, is about an inch to an inch and a half long in the shape of a short “C” or “J”. The elasticity of the abdominal skin helps prevent the incision from stretching, making it even less noticeable. |  | 3. Once the incision is made, an endotube is inserted diagonally through the navel under the skin and fatty tissue to below the breast mound. This creates a tunnel for the insertion of the implants. Both sub-pectoral and sub-glandular placements are possible with TUBA. For sub-pectoral placement, the endotube is inserted further under the pectoral muscle. Placing the implant here results in a more natural slope of the breast.
|  | | 4. & 5. The endoscope (a lighted scope with a camera on a long, flexible rod) is used to determine the correct placement of the tunnels and insertion of the implants, as well as to create a pocket for the implants. |  |  | | 6. The endoscope is removed after the tunnels are successfully created. Dr. Schusterman will then insert a tissue expander, depicted in image 6. The sides of the expander are rolled up to easily fit in the endotube and a long fill tube is attached to the valve in order for inflation to occur. |  | 7. The tissue expander is then pushed through the endotube and is situated where the implants will be placed. The expander is filled with saline using an electric liquid pump or a large syringe for either saline or air.
|  | 8. Depending on the placement of the implant, the breast and connective tissues will slowly separate from either the underlying muscle (sub-glandular) or from the chest wall (sub-pectoral) due to the expansion of the tissue expander, filled approximately 1 ˝ times the desired end volume.
Manual compression may also be done by pushing the implant to each side of the pocket, creating an oversized pocket, necessary for natural movement. Once the tissue has been successfully expanded, the expander is deflated and removed.
|  | | 9. Dr. Schusterman next inserts a long fill tube into an empty breast implant which is rolled up in the same manner as the expander. |  | 10. & 11. The implants are inserted into each end of the endotubes and are positioned in the pockets.
|  |  | | 12. The predetermined amount of sterile saline is injected into the implant using a large syringe. | 
| | 13. & 14. It is possible that you will be elevated to a sitting position after the implants are inserted to check for symmetry and placement. The fill tubes are then removed (fig. 13), the implant valves are sealed, and the incision is closed with dissolvable sutures. A small latex or silicone drain or tube may be inserted for 1-3 days and will be removed at your first post-operative check up. In most cases, this is not necessary. Depending on the needs of the patient, post-operative garments such as surgical bras or ace bandages may be worn. |  |  |
Recovery After TUBA
Once the anesthetic wears off, you will begin to feel some discomfort in the chest and abdomen area, which can be relieved with your pain medications. You will not be able to bend over or raise your arms right away, however most patients report feeling better within 3 to 4 days. It is important to remember that your body is still healing even though you may feel better quickly.
During the healing process over the next few weeks, you may experience a loss of sensitivity, sensations of heat or cold, sharp pains or sensations of crawling skin, or bruising. There is generally more soreness associated with sub-pectoral placement.
Overall, the pain experienced afterwards is less than other breast augmentation methods and the healing process is much faster.
*** The TUBA procedure does not void the manufacturer’s warranty on the breast implant used ***
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