The preferred incision site for breast augmentation surgery for most surgeons is the nipple (periareolar) and the breast fold (inframammary).  Why?  Because they are able to place the implant very close to the incision site which allows for more control.  For women who do not want visible scars on their breasts, however, there are two other options. One is the transaxillary incision in the armpit. The second is the transumbilical breast augmentation (TUBA) incision which is in the belly button. TUBA requires the use of an endoscope, a camera and light on a flexible tube that can be inserted into the body.

Once the tiny incision is made in fold of skin above the navel, Dr. Khalifeh pushes the endoscope along the abdomen beneath the skin where there is a layer of subcutaneous fat.  He tunnels underneath the skin up to the breasts with a blunt instrument called an obturator.  A “pocket” is made in the loose connective tissue behind each breast. The pocket, which is the key to making a natural appearing breast, is difficult to make from such a distance. The empty saline implant is rolled up “like a cigar” and inserted into the tunnel and up to the breasts. It is situated and opened up in the pocket, and a sterile saline solution (saltwater) fills the implant via a fill tube. All this time, the endoscope’s camera allows an inside view of the proceedings. Once the implant is filled, the fill tube and endoscope can be removed. The implant has a self sealing valve that prevents leakage of the saline solution. The small incision is sutured.

The advantages of TUBA include no scarring on the breasts and the insertion of both implants through a single incision site. This site forms a very small, nearly invisible scar. Recovery time is shorter and there is less post-operative pain. The chance of a Staphylococcus aureus (staph) infection is less because the breasts are bypassed. Disadvantages include the lack of control over the surgery due to the distance from the naval to the breasts, the capability of using saline implants only, a greater possibility of asymmetrical breasts due to the difficulty of pocket formation from afar, and the rare but possible chance that the tunnel formed by the endoscope may permanently be seen on the abdomen beneath the skin. If the insertion of the implant is too difficult with the TUBA incision, another incision on the breast may need to be made.

Augmentation surgery takes place in Dr. Khalifeh’s accredited surgical center in Chevy Chase, Maryland under general or twilight sedation.  If an overnight stay is desired, surgery may be held at the Sibley Memorial Hospital in Washington, D.C. where Dr. Khalifeh holds privileges.  Breast augmentation surgery lasts one to one and a half hours. It is best to take at least three days off work. The recovery time is 2-7 days for implants placed over the muscle and 4-7 days if placed under the muscle. Stitches are removed one week after surgery. Another two weeks are necessary before strenuous activity may be resumed. Possible but rare complications include bleeding, infection, implant rupture, asymmetrical breasts, capsular contracture and risks associated with anesthesia.

Call to schedule a consultation about your breast augmentation surgery with Dr. Khalifeh at (301) 244-0148.