1. Is it possible to have sub-pectoral placement (under the pectoral muscle) with TUBA?
2. Is the TUBA procedure a "scarless" breast augmentation surgery?
3. If I choose TUBA, will I have visible tracks from my navel to my breasts for the rest of my life?
4. I have heard that breasts are often crooked, or asymmetrical, with the TUBA approach because it is more difficult to make the pocket.
5. Will it take longer to heal with the TUBA method; will my abdominal muscles be very sore?
6. If I choose to have TUBA, will this method void the warranty issued by breast implant manufacturers?
7. Will I have to remove my navel piercing, and will it close up during the healing phase? necessitating a re-piercing?
8. Is TUBA more expensive than the standard incision methods?
9. If I have a rupture, can you replace my implant(s) through the navel as well or is a visible scar inevitable?
10. Can I have a breast lift and TUBA?
11. Can I get silicone gel or cohesive silicone gel implants with TUBA?
12. Is the chance of infection is greater or lesser with TUBA?
 

1. Is it possible to have sub-pectoral placement (under the pectoral muscle) with TUBA?
Absolutely!  The sub-pectoral placement procedure takes only slightly longer than the sub-glandular, and is widely preferred by many women.

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2. Is the TUBA procedure a scarless breast augmentation surgery?
TUBA is a scarless operation in the sense that there are no visible scars.  The scar is hidden within the umbilicus (navel or belly button) and heals quite nicely and seldom with keloid formation.  However, you may be asked to choose a secondary incision placement just in case there are problems during the surgery.  

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3. If I choose TUBA, will I have visible tracks from my navel to my breasts for the rest of my life?
In the unlikely event that this would even happen now, it is more than likely a connective-tissue failure to adhere to the fascia of the abdomen muscles and not technique-specific.  This was first seen in the initial phases of the procedure  but is no longer an issue with the improved methods and instruments.  If in the event that you may notice tracks post-operatively, it is usually very temporary until the tissue adheres again from the dissection.  However, if this does remain after several months, and this is extremely rare, the tissue may be scored or rasped and the patient is instructed to wear a binder for several weeks.

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4. I have heard that breasts are often crooked, or asymmetrical, with the TUBA approach because it is more difficult to make the pocket.
Asymmetry is almost always present preoperatively in the patient, but in most patients it is unnoticeable. The skill of the surgeon plays a significant part in correctly determining the appropriate implant size and placing this implant in the proper fashion. Asymmetry is just as common in traditional incision placements as TUBA. As with any incision placement, the surgeon will raise the patient intra-operatively and view the position of the breasts in the upright position. If any corrections must be made, they are carried out then. During your pre-surgery consultation, ask your plastic surgeon to view breast implants before and after photos of other patients who have undergone TUBA breast augmentation.

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5. Will it take longer to heal with the TUBA method; will my abdominal muscles be very sore?
There are no incisions on the breasts and no significant amount of sutures to deal with during the healing phase after TUBA.  Hence no tension on the suture lines as with non-endoscopic approaches (areolar, infra-mammary).  Although many patients report less pain and need less pain relievers after TUBA, everyone's pain threshold is different.  Patients usually report a milder healing phase associated with TUBA than with the traditional methods.  However, the subpectoral placement will always have a certain degree of discomfort associated with it considering that the pectoral muscles are dissected from the chest wall to accommodate a breast prosthesis.  Also the abdominal muscles are only mildly affected, the skin is dissected from the muscle fascia and the soreness you feel is from this dissection.  The muscles are not cut or manipulated however they are slightly traumatized.  Patients have compared post-operative discomfort similar to having over-exercised the abdominal muscles at the gym.  Patients describe this feeling as only mildly uncomfortable and lasting as long as a week and a half to two weeks.

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6. If I choose to have TUBA, will this method void the warranty issued by breast implant manufacturers?
This is one of the top misconceptions regarding TUBA.  The implant is rolled up no more than with the trans-axillary (under arm) and areolar incisions.  Only blunt objects ever touch the breast prosthesis.  The implant is never put under any stress or damaged in any way during implantation or during the filling process.  The warranty is not voided.

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7. Will I have to remove my navel piercing, and will it close up during the healing phase necessitating a re-piercing?
You will more than likely be allowed to keep a simple, stainless steel navel ring or barbell intact before your TUBA surgery.  Although you will need to scrub the area gently, but thoroughly, the night before surgery with an antibacterial soap to lessen the chance of infection.  During your surgery prep, your surgeon will more than likely remove your body jewelry and thoroughly sterilize the jewelry and navel area--including in the piercing hole.  However, if this is a newer piercing and there is an infection present (oozing or pus), or the possibility of such, you may be asked to remove it and let it heal before your surgery can be carried out.  Please check with your own surgeon as not all surgeons are comfortable with leaving their patients' body jewelry in during or after the surgery.

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8.  Is TUBA more expensive than the standard incision methods?
Usually TUBA is the same price as any standard incision procedure.  TUBA usually takes less of the surgeon's time and less surgical materials (sutures, surgical sponges, surgical tape, gauze) and operating room time than traditional methods.  Please ask your surgeon what his or her procedure fees are at your consultation.

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9. If I have a rupture, can you replace my implant(s) through the navel as well or is a visible scar inevitable?
There is no reason to have additional scars for a simple ruptured saline implant replacement surgery.  The incision will be made where your original incision was placed, the implant removed and replaced.  In fact,  the replacement operation usually involves less pain that the primary.  This is due to the fact that most of the pain is due to the formation of the implant pocket and tissue expansion--this goes for both sub-glandular and sub-pectoral placement.

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10. Can I have a breast lift AND TUBA?
There is no need for an additional scar in the navel plus abdominal dissection when the breast lift incisions are large enough for implant placement.  Your breast lift incisions, depending upon the technique which will be determined by the degree of ptosis (sag), are more than enough room for sub-glandular and sub-pectoral implant placement.

However, some mastopexy procedures such as the endoscopic breast lift may be possible without scars on the breast.

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11. Can I get silicone gel or cohesive silicone implants with TUBA?
No.  The silicone gel and cohesive silicone implants are pre-filled and must be implanted via the mammary fold or peri-areolar incisions.  Imagine implanting an object the size of a large potato via your navel, hence the need for an infra-mammary or peri-areolar incision. 

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12. Is the chance of infection is greater or lesser with TUBA?
Although there is always the chance of infection due to unforeseen problems such as improper wound and general health care post-operatively (not keeping the area clean, swimming or bathing in water where germs may live, not taking antibiotics, etc.) or the rare chance of bacteria on the surface of the breast implant, chances of infections are usually lessened due to the placement of the incision in the navel and the lack of implant-breast tissue exposure.  The incision is not near the breast tissue nor with some surgeon's techniques is the breast implant ever passed through the actual skin where Staphylococcus aureus naturally lives on the surface of our skin.  Plus the ducts within the breast are never cut or disturbed which would release this bacteria nor is the implant passed through this ductwork where bacteria naturally "lives".  The implant can be passed through an endotube which is inserted into your navel up to your breasts so that it has an untainted passageway into your body.

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