Breast Augmentation: The Belly Button Approach
The belly button approach, also known as Transumbilical Breast Augmentation (TUBA), has been in use since 1991. Dr. Friedman is one of only a few surgeons in Northern California offering this approach and has been successfully utilizing this technique at The Cosmetic and Reconstructive Surgery Center since 1996. This is an endoscopic approach, meaning that only a very small incision inside the belly button is used for implant placement. This results in virtually no visible scarring (the scar is inside the belly button). Because there is no other cutting, there is only a tiny amount of bleeding (generally one to two tablespoons) and therefore less bruising and far less pain as compared to the other approaches used in breast augmentation.
Our experience is that there are lower rates of complications with this approach. For example, nipple sensation loss with the standard approach is two to three percent of patients. With the belly button approach, it is less than one percent. Bleeding or hematoma occur in one to three percent of patients with a standard approach, yet with the belly button approach, it’s less than one percent. Infections occur in one to three percent of standard approaches, while our rate with the belly button approach is less than one half of one percent. Patients also experience a lesser chance of hardening.
A big advantage for women considering pregnancy in the future is that the breast tissue is not harmed in any way with the belly button approach. The implant is simply slid under the breast tissue. No breast tissue or ducts to the nipple are cut or disturbed in any way.
Recovery is far easier and far more rapid with the belly button approach. With standard approaches, it is common for patients to have moderate to severe pain the first one to three weeks. With the belly button approach, the pain lasts, on average, three to five days. It is generally mild to moderate, and patients are ready to resume normal, non-strenuous activities within five to seven days.
Patients often ask how this procedure can be done. Briefly, a small incision is made inside the rim of the navel. A tunnel is made through the subcutaneous fat under the skin and above the abdominal muscles (no body cavities are entered). A long instrument is used to create a pocket for the implant, either under the pectoralis muscle (most common) or under the breast tissue. The empty implant, with fill-tube attached, is rolled up and pushed up the tunnel and into the pocket. The implant is then filled with sterile salt water (saline solution). The fill-tube is then removed which automatically seals the valve. The navel incision is closed with absorbable sutures, and a small drain is placed in the belly button.
Saline Implants:
Smooth Implants: Softer and much less frequently the cause of ripples compared to textured saline implants. We use these implants the majority of the time. Product life: 7-10 years.
Textured Implants: Created originally for silicone gel. When used with saline they have a higher rate of rippling, therefore they must be placed under the muscle. That said, even submuscular placement does not decrease rippling on the sides of the breast.
Silicone Implants:
Smooth Implants: Very soft; however, they can produce more scar tissue and hardening toward the end of their product life (15-20 years) or if there is an early rupture. These implants cannot be placed without an incision on the breast. They create less rippling than saline implants.
DAY ONE TO DAY THREE:
You will experience mild to moderate bruising, mild to moderate swelling, and drainage via the belly button, decreasing on day two or day three. Change the abdominal pads as needed. Under the pad is gauze, and under the gauze is the drain. Do not touch the drain. Some patients will have the drain removed day two or day three. Patients who have their implants placed under the muscle will have more drainage and more discomfort. You should ice continuously for 48 to 72 hours. Activity: Sitting and minimal walking. You should not be doing any bending, lifting, straining, or exercising during this time.
DAY FOUR:
The discomfort is minimal but present (under the muscle placement may still have moderate discomfort). The swelling continues to go down but is still present (more swelling with under the muscle placement). Drainage is minimal. If the drain is still in, it will be pulled out today, tomorrow or on day six. If the drain was taken out yesterday, then you can shower, but do not bathe for one week after the drain has been removed. The gauze may be removed one day after removing the drain. Activity: Sitting and minimal walking, and still no bending, lifting, straining, or exercising.
DAY FIVE:
The discomfort is still decreasing but present. The swelling continues to go down but is still present. Drainage is minimal if the drain is still in or if it was taken out yesterday. If the drain is still in, it will be pulled out today or tomorrow. If the drain was taken out yesterday, then you can shower, but do not bathe for one week after the drain has been removed. The breasts are slightly swollen, more so if implants are under the muscle. Activity: Sitting and minimal walking, and still no bending, lifting, straining, or exercising.
DAY SIX TO DAY 21:
The discomfort in the breast is going away but there are still sore spots. The swelling goes down daily. As activity increases, the breasts may become more swollen and discomfort may increase. You are still restricted in activity, and if swelling and discomfort increase, you are doing too much. Activity: Sitting and minimal walking, and still no bending, lifting, straining, or exercising. You may resume normal activities and exercise three to four weeks after surgery.