Answers to Frequently Asked Questions about
breast enlargement through-the-navel ( TUBA ):

Why are some doctors critical of putting implants in via the navel?

Here are some of the false statements that occasionally are made as criticisms of the transumbilical breast augmentation method ( TUBA ), all due to an absence of information about the details of the method:

• "It is too difficult to do all that work through an endoscope!"
  REALITY: None of the work is done through the endoscope, it is only used to check things as the procedure goes along.
• "It is too difficult to control bleeding that way!"
  REALITY: Because the technique uses pressure, not cutting, there is hardly any bleeding, and control has not been a problem.
• "You can't see what you are cutting way up there!"
  REALITY: There is no cutting going on in the pocket anyway.
• "You can't control the implant placement or position!"
  REALITY: Implant positioning is actually controlled externally during expansion of the pocket, and is very precise.
• "You will void the warranty by pushing the implant through a tube!"
  REALITY: A surgeon who has taken the trouble to study the technique would realize the implant does not pass through any tube at all.
• "You will void the warranty by touching the implant with instruments!"
  REALITY: A surgeon who has taken the trouble to keep current about the technique would realize the implant does not contact any instrument whatsoever.
• "You will void the warranty by using the implant as an expander!"
  REALITY: A surgeon who has taken the trouble to keep current about the technique would know that the implant is not used as an expander anymore.
• "The manufacturer will void the warranty for TUBA because the brochure talks against it"
  REALITY: Late in 2000, the manufacturers confirmed in writing that their warranties are completely intact and honored with the TUBA procedure.
• "You could injure the muscle or other organs!"
  REALITY: There is no penetration into the abdominal muscle or inside the abdomen at all.
• "You will get tracks on the abdominal skin!"
  REALITY: This was seen in the first few cases of the inventor of the technique, but not since the instruments were perfected. (I have never seen it.)
• "It will take too much time!"
  REALITY: This is arguably the most rapid of the augmentation techniques.
• "The chance of complications would be too high!"
  REALITY: Studies have shown that there are fewer complications with the TUBA method than with any other augmentation method. My own experience coroborates that as well.
• "It will be too painful!"
  REALITY: My experience has shown what others have also found: the TUBA method is the least painful, and has the fastest recovery, of any augmentation method known.

1. Certified by the American Board of Plastic Surgery.
2. Considerable experience with breast implants.
3. Strong endoscopic surgical skills.
4. Properly trained and certified in the performance of the TUBA procedure.
5. Personal experience in doing at least ten TUBA cases themselves.

Notice that these are the criteria that I think a surgeon should meet in order to qualify to criticize the transumbilical augmentation as a PROCEDURE. That is not the same as saying that a surgeon needs to meet these same criteria in order to criticize SURGEONS who do not perform the procedure well, which they certainly have a right to do. If a surgeon has managed complications or poor results from another doctor who did the TUBA poorly, even one case might justify concluding that the SURGEON deserves criticism. I personally have extremely negative opinions about some of the doctors who have performed the TUBA ineptly or with taking shortcuts. I can say the same about some doctors who have performed liposuction poorly, or done rhinoplasty poorly. But I would never extend that criticism to the concept of the PROCEDURE itself. I consider myself good at the TUBA procedure, yet I am critical of some of my own early cases where certain things were not yet known, and would likely have gotten a better result if I were to do them today. I criticize myself for those, not the PROCEDURE of transumbilical augmentation.

Doctors who do not meet all of the above criteria are not in a position to be critical of a PROCEDURE that has been used successfully by a number of plastic surgeons, for thousands of highly-satisfied patients. The source of such criticism is often that the surgeon is unable or reluctant to obtain the training needed to perform the procedure. See Why don't more surgeons learn how to do it? for more information. Next time you hear a negative comment about TUBA, find out how many of the above-listed five essential criteria the speaker actually meets. And please let me know if you find anyone who meets all five of these and yet is still critical of the PROCEDURE, I'd like to talk to them! If they are critical of the manner in which certain SURGEONS have performed the procedure, they are welcome to the club, I am critical of those doctors also.

An extreme example of such unfounded criticism:

One of the most ridiculous examples of un-informed criticism about the transumbilical procedure was in an article in 'Mademoiselle' magazine in Spring of 1999. Here is a direct quote from a doctor:

"There is a borderline-insane approach in which the temporarily deflated implant is snaked up through the body from an incision in the navel, because some women prefer to have the incision there - but I don't recommend it, it's killing-a-fly-with-a-cannonball surgery: too complicated and time-consuming for no appreciable difference in results. Most opt for the breast crease, where the only creature to regularly notice it would be your dog."

Now there is a sensitive tactful statement! I am not revealing the doctor's name in order not to embarrass him. Had he been aware of the actual facts, presumably he would not have permitted his quotation to be used, exposing his knowledge deficit in a national magazine.

What can one tell about the doctor from his statement? Only that he has not been reading the medical literature about the procedure, he was never trained to do it, and he has no personal experience in the technique. It is also quite probable that he has never directly spoken with a significant number of women who had their implants put in through the navel.

What are the errors in his statement? Rather than being "too complicated" it is actually the least complicated method. Rather than being "time-consuming" through the navel is in reality the least time-consuming of any method.

What did he leave out? Only the proven information that through-the-navel has the lowest complication rate, the quickest recovery, the least pain, and the best record for preserving sense of touch to the nipples. That's all that he left out.

Did he say anything right? It is correct that the results of putting the implants in through the navel do not look appreciably different from the other methods, other than the inconspicuous scar.

On top of all that, this doctor is not even certified by the American Board of Plastic Surgery! There are many doctors who aren't plastic surgeons who do breast augmentation through the navel. But this particular criticism can only come from someone whose level of understanding of the procedure is that of profound ignorance.

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