Breast Augmentation

Breast augmentation is now the most commonly performed cosmetic surgery operation in the United States. Breast implants are inflatable devices filled with fluid and implanted under the natural breast tissue to create a larger, fuller and often more lifted appearance to the breast. Traditionally, the incisions used in this operation have been placed at the edge of the areola (pigmented area around the nipple), in the crease under the breast or in the axilla (armpit). Big Sky Cosmetic Surgery is pleased to bring you the newest method: trans-umbilical breast augmentation (TUBA), where implants are placed through the navel, using an endoscope.

The TUBA procedure completely avoids scars on the breasts. The incision is hidden in the navel and is usually completely invisible. This procedure is made possible through the use of endoscopic technology. An incision is made in the belly button. A tunnel is then made through the subcutaneous abdominal fat. A pocket is created under the breast; either on top of or underneath the pectoralis major muscle. The implant is placed through the tunnel and inflated. Final adjustments to the implant pocket are made and the incision is then closed. This procedure is commonly performed using local anesthesia with intravenous sedation.

Advantages of the TUBA procedure include:
  • A single inconspicuous scar deep within the navel
  • Less invasive and thus less breast trauma
  • Minimal bleeding
  • Faster recovery
  • Less risk of injury to the sensory nerves of the nipple and breast
  • Shorter operative time
  • Less anesthesia

Misconceptions about TUBA

Relatively few surgeons are trained in this technique and there are a number of common misconceptions. For more in-depth information concerning these myths, see Breast Augmentation/Misconceptions about trans-umbilical breast augmentation in the Questions section.

Implant Types

At Big Sky Cosmetic Surgery, we use smooth, round, saline filled implants that are inflated once they have been implanted. For a more in-depth discussion regarding implant shape and texture, see Breast Augmentation/Breast Augmentation options dsin the Questions section.

Implant Placement

The implant may be placed between the gland and the chest muscles or underneath the pectoralis muscle. The choice of location is determined by the need for adequate soft tissue coverage which is necessary to minimize visibility of the implant edges.
  • Subglandular
    The implant is placed under the gland and on top of the pectoralis major muscle. In appropriate patients, this placement results in a more natural result. It also requires less dissection, is less traumatic and therefore results in a quicker recovery. Some patients do not have sufficient breast and subcutaneous tissue to provide adequate coverage to use his placement.
  • Submuscular
    This approach provides more soft tissue coverage for the implant which is placed underneath the pectoralis major muscle. Typically, the pectoralis muscle is detached from the lower ribs and does not cover the lower portion of the implant. There is also a lower risk of capsular contracture when this approach is used with silicone filled implants. The benefit in reducing capsular contracture is not as significant with saline filled implants. Because some of the muscle attachments are disrupted, this placement is more traumatic and may increase recovery time. In addition, the muscle is slightly weakened however this is generally not significant. Because the implant is partially placed beneath a powerful muscle it will temporarily change shape with vigorous contraction of the pectoralis. This deformation is minimal but may be noticeable to the patient during vigorous exercise.
Implant Size
This is a personal decision determined by patient desires and by what the patientís tissues will accommodate. In general, the larger the implant, the more obvious it will be that an implant is present. The amount of soft tissue coverage is the key to determining how large an implant is reasonable. Also, the larger the implant, the more it will sag over time. We use a system of objective measurements to estimate what is a reasonable sized implant for each patient. We also ask each patient to participate in this process by padding a sports bra to determine the approximate size she wants.

Anesthetic Technique

We have a great deal of experience performing surgery using local anesthesia with intravenous sedation in our office operating room. The recovery is relatively quick. It is well tolerated by most patients who have little if any memory of the procedure. However, if preferred after consulting with our staff about the potential advantages or disadvantages, a patient may choose general anesthesia in the hospital operating room.