The placement of breast implants through a small incision in the belly button was developed in 1991. Since then, the technique has been significantly refined and improved. If the procedure is performed appropriately and by a well qualified and experienced surgeon, it is a safe and reliable procedure. The results would be comparable to the augmentation performed via other incision if not better.

There are a number of misconceptions about the procedure that is propagated by the lay public as well as surgeons not familiar with the procedure.

The current technique involves the following steps:

- The patient is placed under general anesthesia or conscious sedation.

- Local anesthetic similar to liposuction fluid is infiltrated into the belly button and the breast.

- A small incision is made in the belly button.

- A tunnel beneath the skin and above the muscle are created from the bellybutton to each breast either above or below the muscle depending on the patient's preference.

- Endoscopic camera is placed into the pocket to assure the appropriate position of the pocket.

- An expander is placed through the tunnel and positioned under the breast and filled with sterile saline to develop a pocket size sufficient for the implant to be placed.

- The expander is removed and adjustment to the pocket is made with specialized instruments to assure the appropriate pocket size and position.

- The expander is removed and the permanent implant is placed through the same tunnel and filled to the appropriate volume.

- The incision is closed and the dressing is placed.

Here are some of the misconceptions about Transumbilical Breast Augmentation (TUBA) that my patients have brought to the consultations:

- The breasts will be more likely to be crooked. This is most likely information that the patient was given by another surgeon who is unfamiliar with the procedure. In fact, the surgeon has as much control in the positioning of the implants as he would via any other incision. The degree in which the surgeon can place the implant symmetrically depends more on the skill of the surgeon then the access incision.

- The amount of pain will be more because there is pain in the abdomen. Most of the discomfort after the surgery depends on whether the implant is placed above or below the muscle in the breasts. The pain in the abdomen does not significantly add to the discomfort in the breasts.

- There is more bleeding from TUBA. Experience from surgeons who performed significant number of these procedures as is my experience, demonstrated that there is very small likelihood of bleeding after TUBA.

A discussion of the benefits of TUBA cannot be complete without discussing the drawbacks of the scars from other types of breast augmentation. Incision in the armpits, has the advantage of not having scars on the breasts but the scars are now in a very exposed region of the body. The scars can be visible when the patient wears any form of strapless dresses, tank top or bikini.

The incision around the nipples or below the breasts are well concealed in clothes but can be quite apparent when the breasts are exposed. The recent tabloid frenzy about Tara Reid and her breast implants resulted from the visible scars on her breasts.

The TUBA procedure can be performed well with very predictable results and the additional benefit of having a very small scar in a very inconspicuous part of the body, as long as the procedure is performed by a well trained and experienced surgeon.