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Endoscopic Breast Augmentation: TUBA vs Transaxillary

Endoscopic breast augmentation is a minimally invasive method of placing an implant in the breast through a very tiny incision located either under the arm or in the belly button. Potential patients should be aware of the difference between these two methods as they are quite different and only the transaxillary method is fully “endoscopic.”

First of all the TUBA method is quite limited in that it can only place a saline implant and not gel through a long subcutaneous tunnel extending from the belly button to the breasts and many patients are not good candidates for saline. If you do not have much breast tissue to camouflage the implant you will be at higher risk for rippling and implant visibility. In addition, saline implants are firmer than silicone and thus if there is little tissue over them then they will feel very resistant to compression. It is not possible to pass a silicone implant using TUBA.

In addition TUBA is not fully endoscopic since it only uses the scope to find the lower border of the pectoralis muscle and then it is not any different than a blind technique since after the scope passes under the lower border of the pectoralis muscle, the portion of the muscle that needs to be visualized to be divided in order to place the implant is now behind the visual field of the scope. So, the scope is removed and a blunt instrument is placed through the tunnel and the muscle origin is literally ripped off the chest. This is the critical portion of the procedure and visualization is critical to assure that the muscle is divided exactly the same on both sides.

The transaxillary endoscopic technique has several advantages. First of all saline or gel can be placed and most importantly the portion of the muscle that needs to be divided is approached from above (from the armpit looking down toward the muscle origin) so once the scope is under the muscle, the origin of the muscle is fully visualized and in fact the field of view is even better than with the open method, therefore precision is enhanced. the muscle is precisely visualized and divided as opposed to being bluntly torn from it’s insertion.

In addition the transaxillary approach can be used in a much wider variety of situations since the scope can access both the plane under the muscle as well as above, so patients with droopy breasts can be managed with biplanar techniques and even subfascial technique with gel implants which gives much more powerful recontouring of breasts that have lost volume. In fact I can even do a breast augmentation through the axilla approaching it from a periareolar mastopexy if a lift is needed.

In addition since the TUBS can only place slaine, there are certain issues with Saline implants which should be taken into consideration, although they are fine in certain patients. these pros and cons of saline vs silicone are discussed under that heading elsewhere.

In short, the TUBA technique is a blunt and blind method of placing only saline implants and in my opinion the only advantage is to the surgeon since it is very fast, so the surgeon can offer the technique at a low price and just do a lot of cases in one day to make up the difference. It also has it’s own set of complications such as visible scar tunnels running from the umbilicus to the breasts and also scarring to the belly button.

I looked closely at TUBA over 10 years ago and felt that the transaxillary method offered my patients much more flexibility, a more precise result, and still with no scar on the breast so I have been using it now for over 20 years and have the longest experience with it in the world among active surgeons.

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