Tuba

rxy54 · 07-05-2009, 03:12 PM

Dr. Mele,

I am considering doing my breast augmentation through my belly button and I wanted to get your opinion about this incision site. I know alot of doctors don't do breast augmentation this way and throught the arm pit because the lack of control but I am going to a dr. that was referred to me by a close friend who was one of the first Dr. in the U.S. to do the TUBA and opened the first clinic in southern cali offering TUBA. So I am confident in his ability. My friend loves him but she didn't do TUBA, she had a lift and augmentation.

I wanted to ask if alot of dr don't perform TUBA because they are not confident in doing the procedure because of their ability, or if they disagree with it all togeter? And how common do you think it is to get scar tissue in the abdomin after the procedure? My dad is a physican and does not want me to have it done this way because he doesn't want me to develope scar tissue in my abdomin and believes its unavoidable, but I asked my PS assistant and she said she rarley has anyone with that complication and TUBA is the incision site they perform most of their breast augmentation's. Do you think the arm pit may be better? I'd rather not have a huge visable scar. Thanks for you time.

Dr. Mele · 07-06-2009, 01:10 AM

Dear Rxy54:

I have trained how and am comfortable with the TUBA and I don't do it. I spent the time to get to know the procedure, but I think it is trying to fix a problem that doesn't exist. Most patients get fine line scars that are in the most discrete of locations. So doing TUBA to avoid a bad scar makes no sense to me. The abdomen does not heal better and in the rare chance that you are going to get a bad scar, why would you want it in such a visible place.

Silicone gel implants should not be placed via a TUBA or axillary incision, because the implants are frequently damaged with these methods and leak.
If you are going to use saline the peri-areolar scar heals very well and is better hidden. In my opinion the periareolar location also gives the best possible scar.

I am very comfortable doing surgery with long instruments and video monitoring. I have my surgical boards in both General Surgery and Plastic Surgery. I have removed hundreds of gall bladders in my training with a scope and can do it better than the open technique, but there is a huge advantage to the patient to do the surgery this way. Their recovery is much easier and much faster. There is no similar advantage with TUBA.

If you had a brand new car. I could drive it from the back seat with sticks, but I think you would be more comfortable with me sitting in the front seat. Most plastic surgeons are gifted surgeons with lots of confidence, so it is not a lack of confidence that keeps the majority of plastic surgeons from doing breast augmentation via the TUBA method. It the TUBA operation that keeps most plastic surgeons from doing it.

To me it just doesn't give me or my patients enough benefit to warrant the increased risks (asymmetry, injury to the implant, inability to use silicone gel implants, pain in the abdomen, scar in a more visible position.

Additionally, there is one person in my area who uses this technique. He is not a Board Certified Plastic Surgeon. I have fixed more of his belly-button scars than my own breast scars. I do a lot of breast augmentations and I see all of my patients. I only see his unhappy patients. So I am not sure that umbilicus gives a better scar.

I know you probably are not liking my answer, but it is an educated answer, and it is my opinion. If you have read these boards, you realize that if you have breast augmentation, you may require additional surgery. Revision surgery usually cannot be performed via the umbilical or axillary incisions as they do not provide adequate visualization.

I hope this gives you some good information to use, and I guess I have to side with your father on this issue.

rxy54 · 07-06-2009, 11:51 PM

Thanks for all of the information. I will def. keep it in mind. I appreciate your time. Take care.

07-05-2009, 03:12 PM	#1
rxy54 Less then 1 week, ahhhh 12/9/09! Join Date: Jun 2009 Location: Apple Valley, California Posts: 157 Thanks: 190 Thanked 43 Times in 30 Posts	Tuba Dr. Mele, I am considering doing my breast augmentation through my belly button and I wanted to get your opinion about this incision site. I know alot of doctors don't do breast augmentation this way and throught the arm pit because the lack of control but I am going to a dr. that was referred to me by a close friend who was one of the first Dr. in the U.S. to do the TUBA and opened the first clinic in southern cali offering TUBA. So I am confident in his ability. My friend loves him but she didn't do TUBA, she had a lift and augmentation. I wanted to ask if alot of dr don't perform TUBA because they are not confident in doing the procedure because of their ability, or if they disagree with it all togeter? And how common do you think it is to get scar tissue in the abdomin after the procedure? My dad is a physican and does not want me to have it done this way because he doesn't want me to develope scar tissue in my abdomin and believes its unavoidable, but I asked my PS assistant and she said she rarley has anyone with that complication and TUBA is the incision site they perform most of their breast augmentation's. Do you think the arm pit may be better? I'd rather not have a huge visable scar. Thanks for you time.

07-06-2009, 01:10 AM	#2
Dr. Mele Certified by the ABPS Join Date: Feb 2009 Posts: 272 Thanks: 120 Thanked 288 Times in 152 Posts	Dear Rxy54: I have trained how and am comfortable with the TUBA and I don't do it. I spent the time to get to know the procedure, but I think it is trying to fix a problem that doesn't exist. Most patients get fine line scars that are in the most discrete of locations. So doing TUBA to avoid a bad scar makes no sense to me. The abdomen does not heal better and in the rare chance that you are going to get a bad scar, why would you want it in such a visible place. Silicone gel implants should not be placed via a TUBA or axillary incision, because the implants are frequently damaged with these methods and leak. If you are going to use saline the peri-areolar scar heals very well and is better hidden. In my opinion the periareolar location also gives the best possible scar. I am very comfortable doing surgery with long instruments and video monitoring. I have my surgical boards in both General Surgery and Plastic Surgery. I have removed hundreds of gall bladders in my training with a scope and can do it better than the open technique, but there is a huge advantage to the patient to do the surgery this way. Their recovery is much easier and much faster. There is no similar advantage with TUBA. If you had a brand new car. I could drive it from the back seat with sticks, but I think you would be more comfortable with me sitting in the front seat. Most plastic surgeons are gifted surgeons with lots of confidence, so it is not a lack of confidence that keeps the majority of plastic surgeons from doing breast augmentation via the TUBA method. It the TUBA operation that keeps most plastic surgeons from doing it. To me it just doesn't give me or my patients enough benefit to warrant the increased risks (asymmetry, injury to the implant, inability to use silicone gel implants, pain in the abdomen, scar in a more visible position. Additionally, there is one person in my area who uses this technique. He is not a Board Certified Plastic Surgeon. I have fixed more of his belly-button scars than my own breast scars. I do a lot of breast augmentations and I see all of my patients. I only see his unhappy patients. So I am not sure that umbilicus gives a better scar. I know you probably are not liking my answer, but it is an educated answer, and it is my opinion. If you have read these boards, you realize that if you have breast augmentation, you may require additional surgery. Revision surgery usually cannot be performed via the umbilical or axillary incisions as they do not provide adequate visualization. I hope this gives you some good information to use, and I guess I have to side with your father on this issue. __________________ Joseph A. Mele, III, MD, FACS Certified by the American Board of Plastic Surgery Certified by the American Board of Surgery www.DrMele.com

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07-06-2009, 11:51 PM	#3
rxy54 Less then 1 week, ahhhh 12/9/09! Join Date: Jun 2009 Location: Apple Valley, California Posts: 157 Thanks: 190 Thanked 43 Times in 30 Posts	Thanks for all of the information. I will def. keep it in mind. I appreciate your time. Take care.