With over 230,000 cosmetic breast augmentation surgeries performed each year in the United States, it is not surprising that a unique procedure called TUBA has emerged into the forefront of cosmetic surgery. NI Magazine had an opportunity to meet with Dr. Robert A. Shumway, MD, FACS to discuss TUBA, (Transumbilical Breast Augmentation).  With over eleven years of surgical training and twelve additional years of breast augmentation experience teaching the TUBA technique, Dr. Shumway is the premier physician on the West Coast performing Transumbilical Breast Augmentation.

 
The TUBA Procedure
The surgery is performed by making a small curved incision around the upper rim of the belly button. Using a slender instrument, a narrow tunnel is made under the skin through subcutaneous fat which extends to the breast. After creating surgical pockets to house the implants, inflatable tissue expanders are inserted through the tunnel and placed into position to further shape the pockets. This gives the physician an opportunity to determine the correct position of the implants even before their final placement.

Tissue expanders are used first and then the actual breast implants are inserted through the subcutaneous tunnels in a rolled up fashion (like a cigar) into the newly created pockets. The implants are then filled with sterile saline from an IV bag through soft plastic fill tubes. The fill tubes are removed after checking the patient for symmetry in various positions. A one-way valve in the implants instantaneously seal themselves as the tubes are withdrawn. Once the implants are filled and checked again for symmetry, the navel incision is closed using dissolvable sutures.

Because the procedure is done under local tumescent anesthesia (not general anesthesia), the patient is able to sit up and move when asked to do so. This helps with the overall surgical results and provides for a quick recovery after surgery. The patient is allowed to go home the same day.

 
TUBA Advantages
Dr. Shumway states, "The most obvious advantage of TUBA is that there are no breast or chest scars as with other augmentation surgeries, i.e., the periareolar (around nipple), inframammary (under the breast) or transaxillary (through the armpit). Additionally, the recovery time is significantly less. Patients are able to move their arms immediately after surgery and most people return to work within three days! After two weeks, patients are able to lift heavy objects and resume normal activities."

TUBA takes less surgery time to perform because it takes less time to close one small incision than two larger incisions. Also, the navel closure is multi-layered and generally heals very quickly. Another big advantage of TUBA is that the single, remote navel incision site results in a much lower incidence of implant infections.

Another benefit of TUBA, Dr. Shumway explained, is that other procedures can be performed concurrently with TUBA. For example, umbilicoplasty (naval reshaping) and abdominal liposculpture can be done through the same umbilical incision following the placement of breast implants.

 

TUBA Facts, Misconceptions and Myths
Transumbilical Breast Augmentation was initially developed in 1991 by Dr. Gerald W. Johnson, MD of Houston. Dr. Johnson has performed over 4,000 TUBA procedures and conducts seminars to teach physicians how to use the technique, as does Dr. Shumway. Even though TUBA has been performed successfully for more than 15 years, it is still considered a "new procedure." There are less than twenty-five surgeons around the country who perform the procedure.  Dr. Shumway, has been successfully performing and teaching the TUBA technique to other physicians for more than a decade.

Myth:
Only a few types of breasts can be augmented with TUBA.
Fact:
Many different breast types and shapes can be implanted by TUBA. This includes breasts that are asymmetrical, ptotic (droopy), tubular or restricted. Even patients who suffer from a pectus deformity (chest wall abnormality) are TUBA implantable with excellent results.
 
Myth:
The procedure is more expensive than other types of breast augmentation.
Fact:
The cost of TUBA at Shumway Cosmetic Surgery is the same as the other approaches.
 
Myth:
It is not possible to place the implants in the subpectoral position (under the muscle).
Fact:
In the early stages of the technique, breast implants were placed in the subglandular position (over the muscle). With more experience, we discovered that subpectoral implantation was equally possible with the endoscope. The majority of Dr. Shumway’s TUBA surgeries are performed in the subpectoral position.
 
Myth:
A breast lift cannot be performed in conjunction with TUBA.
Fact:
False. Once the implants have been placed, a nipple lift mastopexy can be achieved through a superficial half circle incision around the upper areola. This superficial incision will not transverse all the way through the skin, and therefore does not violate any breast tissue.
 
Myth:
The procedure can not be performed if the patient has had other abdominal surgeries.
Fact:
If a patient already has an abdominal scar from a previous operation, this incision can be used as an entrance portal in which to place the implants and this scar can be improved in the closure process! A new incision around the navel would not even be needed. Dr. Shumway calls this method the Transabdominal Breast Augmentation (TABA).
 
Myth:
The manufacturer’s warranty on the implants is void when using TUBA.
Fact:
This is one of the most prevalent misconceptions. The implants are protected in the same manner as with the other non-TUBA surgeries. The implants are never placed under any stress or damaged in any way during implantation. The implant manufactures have always stood behind their warranties.
 
Myth:
The procedure can cause liver damage or perforate internal organs.
Fact:
All TUBA instruments pass through subcutaneous tissues which are above the abdominal musculature. No internal body cavities are entered and no internal organs are violated.