But just how does a plastic surgeon insert breast implants through a belly button?

First, the patient is placed under a general anesthesia; the whole procedure goes better if she lies still like a statue. Local anesthetics are injected into the umbilicus (the belly button) and breast.

Then, the plastic surgeon makes an inch and one-half long incision in the umbilicus and creates two tunnels just under the skin, one apiece leading to a breast. The surgeon has the choice of ending the tunnels above or below the chest muscle to make an implant pocket.

A tiny light and camera inside the tunnels then checks the pockets’ position.

After that,  empty breast implants are rolled up like a cigar, inserted through the tunnels and placed in the pockets. They are then filled with saline to expand the pockets. (The expander filler tubes hang out of the belly button incision.)

After removing the expander, yet another long instrument checks the position of the pockets to make sure the new, enhanced breasts will be balanced and symmetrical.

The next-to-last step is placing the permanent breast implant through the tunnels and filling them to the size the patient wants.

Only saline breast implants are used; silicone implants are already, permanently filled and won’t fit through the tunnels.

Last item?  Closing the incision and applying a dressing.

While recovering, the patient will notice some pain in her stomach near the tunnels and more discomfort if the implant has been placed below the chest muscle. However, adherents say there is less bleeding during a TUBA procedure and a quicker recovery with less risk to breast and nipple nerves.

As in all plastic surgery procedures, a practitioner who does the procedure often – once or twice weekly  – is more likely to produce the best results.

Despite all that, many plastic surgeons writing in RealSelf.com don’t recommend TUBA because the procedure is difficult unless the surgeon is highly skilled and experienced.

One way to check: the surgeon should have many, many breast augmentation before and after pictures of his past TUBA patients.

When a woman thinks about having breast augmentation with implants, she has three choices where the implant is positioned:

• Over the chest muscle
• Under the chest muscle
• Under the thin, tough sheet of tissue, the fascia, covering the chest muscle

All three have their advantages and disadvantages so no one position is right for every patient. 

The basic drawbacks to the subglandular position over the chest muscle are: 

• Any rippling in the implant can be seen and felt through the skin
• Mammography is more difficult
• Capsular contracture, a painful scarring and hardening of the breast is more common
• Implants are more likely to fall down into the breast pocket, or, “bottom out”

But the procedure, also known as the submammary placement, is quicker for the surgeon to do, involves less recovery time and, most likely, less expense. If something goes wrong with the implant later, it’s easier for the surgeon to reach. 

When a plastic surgeon puts an implant under the chest, or, Pectoralis muscle, he or she usually cuts the muscles in half, creates pockets, places the implants and sutures the chest muscles back. That creates more recovery time and expense because the technique is more difficult to master. (Note: muscle cutting can be avoided by entering the breasts through the armpits.) 

But a larger implant may be required because the chest muscle presses down on the implant. 

However, the technique also offers: 

• Low risk of capsular contracture
• A softer and more natural feel
• Rarely seen bottoming out

The third option, placing implants under the fascia, also has many advantages, according to an article in the October, Aesthetic Plastic Surgery, a publication for cosmetic plastic surgeons. 

Three plastic surgeons in Nuevo Leon, Mexico, reviewed the records of 1000 breast enhancement patients over 10 years who had soft gel breast implants placed under the fascia covering the chest muscle.  

The surgeons entered 95 percent of the breasts through an incision in the inframammary fold, the area under the breast at the chest wall. 

The surgeons/authors found: 

• Less post-op pain
• A shorter operation
• Quicker return to daily activities
• Better projection (how far out in front the breast projects)
• Reduction of capsular contracture
• Less morbidity than subglandular and submuscular methods

(Read the fascia breast augmentation article.)

You read it here first!

Back in July, 2009, readers of the California Breast Augmentation Institute Blog learned how your own fat can be used to enhance your bust line. (Read our post about natural breast augmentation.)

Now, plastic surgeons at the annual American Society of Plastic Surgery meeting in Seattle have released a study showing that fat — taken by liposuction — is a viable alternative to breast implants.

The study is noteworthy because breast augmentation saw 307,000 procedures in 2008; it was the leading plastic surgery performed in ‘08, the most recent year for which statistics exist.

However, breast implants present rare — but possible — risks including:

• Breakage and leaking
• Infections
• Attracting painful scar tissue
• Causing a replacement operation

The basic concern about fat transplantation to the breast was that the fat could die, form calcium cysts and block mammograms.

Other cosmetic plastic surgeons feared the fat might be reabsorbed by the body.

Plastic surgeon Roger K. Khouri, M.D. and colleagues studied 50 women, aged 17 to 63 for five years; all had breast enhancement with almost nine ounces of fat taken from each thigh.

Results included:

• Fat transfer to the breast did not obscure mammography
• Fat survival averaged 85 percent
• Patients said they were pleased with the natural breast feel
• The average increase was one bra cup size

New techniques included having patients wear a bra-like tissue expander device 10 hours daily before and after plastic surgery to make room for the transferred fat.

The researchers used a tiny liposuction tube only 2.7 mm (about 1/16^th of an inch) wide.

The fat was cleaned by sedimentation and re-injected into each breast through 10 to 14

needle puncture sites in three-dimensions.

Many fat transfer experts have found that injecting a pool of fat does not work because such a large glob does not easily find a blood supply. However, tiny pearls of fat do if they are spread out.

The researchers also took a series of MRIs and mammograms before and after surgery.

The operation required an average one and one-half hours while the patients returned to their normal activities within three to four days.

While the vast majority of breast enlargement patients were happy with their surgical outcome, breast surgery is like any other surgery: even in the best of hands, unforeseen complications can crop up.

So what are the signs a woman might notice in herself that something has gone wrong after breast augmentation?

Warning signals include:

• Changes in nipple sensation

Several invasive cosmetic plastic surgeries – like breast enlargement and liposuction – can leave the skin in the treatment area with a slight numbness. It’s almost always temporary because the nerves grow back.

• Fever

A high fever can be more serious because it may indicate an infection. Other signs of infection include redness around the incisions. If you notice that in your incisions, you should call your surgeon right away. If he or she is a board-certified plastic surgeon, that doctor will have seen – and treated – all the possible complications.

• Muddy mammograms

Tell your radiologist you have breast implants; sometimes, one or both implants can obscure the X-rays. But additional pictures from different angles can be taken.  Ultrasound or magnetic resonance imaging can also be done.

• Hardness of the breast

The natural healing process can form scar tissue that surrounds and squeezes your implants in varying degrees. That can cause the breast(s) to feel tighter than normal. Your surgeon needs to evaluate it sooner rather than later.

• Changes in breast size

If a breast looks like it is deflated, it could be because the implant has leaked. For a saline implant, the filler leaks harmlessly into the body. Your doctor needs to know because surgery may be required to replace it. The good news? Many implants have warranties.

• Sickness after surgery

The best way to prevent nausea after your procedure is to make sure you have a board-certified anesthesiologist.(Tip: use a little doctor slang and ask your surgeon who the “gas passer” is going to be. They’ll both be charmed by your insider knowledge!)

The best way to handle complications: discuss them before surgery with your surgeon and ask the doctor who would beresponsible for what treatments in case one of these rare complications rears its ugly head.

Tubular breasts are considered a bona fide medical deformity, even though most patients with the condition are not aware they have an actual deformity. Most just assume they have very small breasts. Some aren’t aware a correction is possible

As you might guess from the name, Tubular breasts are usually small, very long and narrow, have large areola and often sag even though the patient is a teen or very young woman. In some places, Tubular breasts are known as “snoopy breasts”.

Often, a Tubular breast patient requires only an A or AA cup and is usually embarrassed about her appearance.

For instance, one patient with size AA tubular breasts who finally had her breasts surgically corrected recalled how humiliated she felt during her competitive swimming career when she showed up at poolside in a skin tight Speedo bathing suit.

Away from the pool, she wore a padded bra. After her breast enlargement, she shed tears of joy the first time she saw the results and was over the moon with her new, natural appearance.

It requires extreme skill to correct the condition because the surgeon must do, all in one surgical session a:

• Breast enhancement
• Breast lift
• Breast reduction

The surgeon enlarges the base of the Tubular breasts — and makes room for the implants – by reaching down from the areola and making a series of incisions around the bottom of the breast. Surgeons who use that approach say it also reduces the overly large areola.

That does two things:

• Reduces the projection of the tubular breasts
• Creates a natural-looking cleavage between the breasts

Some surgeons prefer to enter the breasts from the inframammary fold, the area where the very bottom of the breast meets the chest wall.

View examples of tubular breast correction in a surgeon’s before and after pictures.

Breast enhancement is the leading invasive cosmetic plastic surgery. But don’t take it lightly — it is real surgery so all the precautions are taken with breast enlargement patients as with all other patients for any surgery.

Some good questions to ask before going ahead include:

1.    Who is the provider? Some of our past posts tell about board certification. So try and find a surgeon with board certification in plastic surgery and who performs the procedure at least three times weekly.

2.    Nursing? If you want more children, the rule of thumb is: the larger your breast implants, the more likely you will not be able to breast feed. Your surgeon will help your resolve this question.

3.    Where to have it done? Statistics show that about half of cosmetic surgeries take place in surgeons’ offices. Better choices include freestanding, certified surgery centers where you will have extensive medical backup available in the unlikely event that anything goes wrong. Breast surgery is also done in hospitals.

For  surgical centers, the certifications to look for include:

• JCAHO (Joint Commission on Accreditation of Health Organizations)
• AAAFC (Accreditation Association  for Ambulatory Surgical Facilities)
• AAAA SF (American Association for the Accreditation of Ambulatory Surgical Facilities)
• State or Medicare licensure

4.    Complications? Ask your surgeon what complications you may encounter. The major ones include capsular contracture and infections.

5.    Cost? The average surgeon cost of a silicone breast augmentation during 2007 was about $4000, with saline running about $3500.

But separate fees for the anesthesiologist and the use of the operating room can run another $1000 to $1500, depending on your area of the nation.

6.    Choice of incision? There are four routes through the skin plastic surgeons use to place breast implants: through the areola, the armpit, the naval and the inframammary fold, the place where the very bottom of the breast mound meets the chest.

Medically known as breast asymmetry,  Dr. Matas cautions new patients that surgical correction sometimes offers only a 60 percent improvement.

Asymmetry may occur during the teen years  while developing or through:

• Trauma
• Infections
• Burns
• After breast feeding

Plastic surgeons say the asymmetry can be visible in several different ways, including:

• A missing breast
• Different sizes
• Various shapes

The unbalanced bust line can cause extreme worry for teens who often become withdrawn. For younger patients, buying a bra or a prom dress is a terrible experience.

Adults may be inclined to back away from intimate situations because of embarrassment. Both groups suffer a loss of self-esteem and confidence with some becoming depressed over their physiology. They also shy away from anything to do with pool or beach wear.

The American Society of Plastic Surgeons studied 35 patients who had surgical breast asymmetry procedures. After six months, the researchers found all the study subjects had “statistically significant”  improvements in:

• Vitality
• Mental health
• Self-esteem

But what does a surgeon actually do to correct the appearance of unbalanced breasts? Plastic surgeons have three surgical procedures at their disposal, including:

• Breast lift
• Breast augmentation
• Breast reduction

“Even if breasts are different by less than a half-cup size, it can be very noticeable,” said plastic surgeon Walter Erhardt, M.D.

Do you have trouble buying tops that fit well?

In the United States, virtually all injectables are used somewhere on the face, with a few cases being used to plump up and make aged hands look more youthful.

But a new trend taking place in England and the rest of Europe just may make it to American shores.

The product is Macrolane Gel, a long-lasting filler made of hyaluronic acid, a naturally occurring substance and also found in Juvederm and Restylane. (Read our past post on likely new plastic surgery procedures coming to America.)

The procedure? Breast augmentation!

Nick-named, the “boob jab” in England, Macrolane can be injected to increase breast size in an hour to 90 minute procedure. The surgeon uses only a topical anesthetic while the patient is awake. Plus, there is no recovery period from Macrolane breast enlargement, no scars and no foreign objects in the body.

But there are downsides.  And how!

Start with the cost of the breast augmentation: plastic surgery is a bit more pricey in England so a typical injected enlargement costs about $5000.

A Surgicare report on the breast enlargement procedure lets the big cat out of the bag: the enlargement only lasts 12 to 24 months.

(Surgicare bills itself as a United Kingdom specialist in cosmetic surgery and non-surgical treatments.)

The enlargement lasts so shortly because the human body absorbs hyaluronic acid. So you are  soon back to where you started. After that, you must go back for another treatment if you want to keep the look.

Another British cosmetic surgeon, Dr. Rita Rakus (“The London Lip Queen”) says on her website she extends the use of Macrolane to:

• Buttocks augmentation
• Calf augmentation
• Male chest shaping
• Post liposuction concavities

(Concavities? A few  liposuction procedures take out too much fat, allowing the skin to shrink into a small depression in the treated area.)

But plastic surgeon Steven H. Williams, M.D. blogs that 1000ccs of Macrolane in a breast could block the X-rays used to check for cancer.

Once the economy recovers, do you think U.S. women will go for Macrolane?

Why?

For starters, here are some of the unexpected detours a typical breast augmentation can take. Even in the best of hands, a small (less than one percent) number of cases may experience any of the following conditions:

• Bottoming out

In this scenario, the breast implant has not been placed in the chest pocket correctly and falls to the bottom of the breast, causing the nipples to point up. It’s difficult to fix and usually requires a breast revision specialist. Plus, the cost is usually equal to twice the original cost of the breast enlargement.

• Capsular contracture

Sometimes, the body’s natural reaction to a foreign body – like a breast implant – is to wall it off with scar tissue. It’s one of the most frequent complications.

Capsular contracture can squeeze the implant and breast, making it hard to the touch. Implants placed under the chest muscle have less contracture, plus really skilled surgeons know how to place two-thirds of the implant under the muscle, with one-third over that muscle.

• Implant rupture

Although uncommon, both saline and silicone breast implants can leak if they are ruptured. In the case of a saline implant, the affected breast will collapse. A rupture of a silicone implant is harder to detect because the contents inside are a cohesive silicone gel. Either way, an additional surgery will be required.

• Change of mind

The most frequent reason for another surgery following a breast augmentation is because the patient sees the final result and wants a larger bust line. (About 10 percent want a smaller implant.) A well trained surgeon can give you good advice because he or she knows how to rate various factors – like the base diameter of the patient’s breast, shoulders, hips and general body build – to recommend an implant for a breast size that best flatters you. The board-certified surgeon will also consider your profession and culture in recommending a final size for your bust line.

Have you ever considered breast augmentation?

• Breast augmentation
• Breast reduction
• Breast lift

say about two percent of the female population have inverted nipples which are turned inward into the breast rather than standing upright.

The condition is usually due to genetics, while some infections and conditions can cause it.

Nonetheless, affected women seek help from plastic surgeons because:

• The look is unattractive
• They are inhibited in intimacy
• Breast feeding can be a problem

Usually, the inverted nipple is held inside the breast due to scar tissue or muscles just below the skin’s surface.

In most cases, the plastic surgeon uses small incisions into those internal breast muscles to allow the nipple to release and pop up. In some cases, the woman loses the breast feeding ability because the milk ducts are severed.

One study revealed another way to repair inverted nipples is using a needle, smaller incisions and  putting the nipples in traction for a week.

Known as the Stevens Stent, the technique works like this:

The surgeon releases the muscles with a tiny incision next to the milk duct, uses a small hook to pull the nipple upright and then places stitches internally around the nipple at the 12, 3, 6 and 9 o’clock positions.

After that, the surgeon puts surgical gauze and a small medical cup a little larger than a thimble over the nipple to protect it and the surgical site. The stent is removed after five days. The stitches dissolve automatically.

Appearing in a magazine for plastic surgeons, the Aesthetic Surgery Journal, the article told how 21 nipple/stent patients were followed for one year. All reported their nipples had stayed upright during the year after breast surgery.

Would you have plastic surgery if you had inverted nipples?