La Jolla, Calif. -- Cosmetic surgeons interested in a faster and safer alternative to traditional breast enlargement procedures might want to look at an approach that leaves no scars on the breast. Called TUBA (Transumbilical Breast Augmentation) the innovative approach was first developed by Houston surgeon Gerald Johnson, M.D., in 1991. The procedure requires one incision at the navel--no other incisions are necessary, according to Robert A. Shumway, M.D., FACS, medical director of the Shumway Institute of Laser and Cosmetic Surgery in La Jolla, Calif., who has performed the surgery on thousands of patients since 1996.
"The TUBA method is the safest and most effective way to achieve breast augmentation for patients, with less chance for complications both during and after surgery," Dr. Shumway said. Along with a small number of other members of the American Society of Cosmetic Breast Surgery, Dr. Shumway performed studies to evaluate the safety and effectiveness of the navel method to breast augmentation. Results have shown the safety factor to be higher than that of other approaches.
On the effectiveness scale, the most powerful data comes from the patients, themselves.
More than 95 percent of Dr. Shumway's patients are thoroughly satisfied with the outcome of the TUBA approach, he said.
But the most important message Dr. Shumway delivers to surgeons interested in learning to perform the procedure is its safety. The TUBA method can be done under tumescent local anesthesia, which makes it a safer procedure. The surgery involves a small incision along the inside rim of the navel (and nowhere on the breast or breast tissue), and superficial tunnels above the rectus abdominis muscle through which the tissue expanders and implants can be slid under the skin and placed either above or below the pectoralis major muscle. Because there is minimal bleeding, cautery and surgical drains are unnecessary. As a result, patients recover quickly without postoperative pain. In addition, the single, distant navel incision decreases the chance of a skin or implant infection by more than 50 percent.
Theoretically, the decreased rate of infection may correlate to a decrease in the amount of capsular contraction. However, the rate of contraction appears to be no greater than any other augmentation methods, according to Dr. Shumway.
The TUBA method does require that surgeons carefully screen candidates. "Generally, healthy women of all ages with relatively symmetrical breasts who possess reasonable expectations will make the best postoperative patients," Dr. Shumway said. "These are the women who will get the best results. As a university surgical instructor, I teach other cosmetic surgeons to begin with reasonable cases like this."
While TUBA isn't designed to completely replace existing procedures, "It should be added to a physician's augmentation options," he added. "Physicians need to understand that if they are proficient at other approaches first, then they may progress to performing the TUBA. They can then have confidence and understand what they are doing by feel, external visualization, and experience relative to an open approach. However, they can visualize their work by endoscopy while 'under cover' and actually learn to perform this procedure more quickly than the open approach."
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But Dr. Shumway cautioned, "This is a very attractive alternative route to augmentation, and physicians need to be proficient breast-augmentation surgeons first. If surgeons ever have to revert to the open approach, they should know how to perform that procedure. After physicians have augmented more than 100 patients, the next step is to learn the TUBA approach through the navel."
Dr. Shumway offers these suggestions to surgeons:
- First, be sure to anticipate that patients will recover twice as fast as they might with other breast-augmentation procedures.
- Second, provide superb postoperative care to the patient for the first month to make sure that the pockets they have created are sufficient for the implant that has been used, and mobile enough to reduce the chance of premature capsular contracture.
- Third, make sure to take the time during the procedure to generate perfect symmetry in the pockets.
Is the TUBA procedure controversial? "Yes, but only in the minds of those who don't understand it," Dr. Shumway said. "Some believe that the internal organs can be injured ... that is emphatically, absolutely not true. And some surgeons wonder if going through the navel will void the manufacturer's warranty ... again, the answer is emphatically no."
Furthermore, to complement the TUBA procedure, a variety of contouring and body-sculpting techniques around the abdomen and hips can be performed.
Surgeons can use tumescent liposuction or ultrasonic liposuction concurrently with TUBA to further reshape and enhance the body, using the TUBA incision. Currently, almost 50 percent of patients opt for more than one procedure to be performed during breast augmentation.
"The TUBA approach was not designed to eliminate all of the other breast-augmentation approaches," Dr. Shumway explained, "but it is definitely a wonderful and ultramodern alternative, and there are times when it proves to be faster and better."