... Plastic Surgery Seattle your source for information on the services of Seattle cosmetic surgeon, Dr. Jourdan Gottlieb ...
Transumbilical Breast Augmentation Procedure
T.U.B.A. is often performed in less than an hour using general anesthesia.
Just before your surgery Dr. Gottlieb will mark you for surgery and you will be taken to the operating room. These markings will indicate where the tunnels will follow up to the breast as well as the pocket dissection dimensions and lowering of the mammary fold (crease under the breast), if necessary.
After you have been sedated, prepped and stabilized Dr. Gottlieb will perform the injections of local anesthetic around and in the navel and all around your treatment area. He will then make the appropriate incision in your navel and begin local dissection of the tissues around the umbilicus (navel).
Dr. Gottlieb will then insert an endotube which will be used to tunnel from the umbilicus to the breasts. Blunt dissection is used to separate the fat and skin from the muscle fascia from the navel entry point to beneath a predetermined point underneath the breasts.
After both tunnels are created, the endotube is inserted under the breast mound. The diagram depicts a sub-glandular pocket being inspected for correct placement for the pocket formation. Sub-pectoral placement is also possible with T.U.B.A. If sub-pectoral placement is desired, the endotube is further inserted under the pectoralis major to bluntly dissect it away from the chest wall and pectoralis minor. The pectoralis major is the larger of the chest muscles which branch from the shoulder and arm. This is generally the muscle that you would tone up by performing a butterfly curl or bench press. With this placement a more natural slope of the upper poles of the breast mound can be achieved.
After, and sometimes during, the formation of the tunnels or general dissection, an endoscope, which is a small camera, will be inserted to ascertain the correct formation and placement of said tunnel. Once the endoscope is inserted through the navel, Dr. Gottlieb will be able to see via a monitor where and what has been done or what still must be done in order to achieve a properly placed tunnel.
After the tunnels have been successfully created either above or below the pectoral muscle, the endoscope is removed. Next, a tissue expander, as depicted at the left, will be rolled up on both sides so that it will easily fit within the endotube. There will be a long fill tube attached to the valve through which it will be inflated.
The tissue expander will be pushed through the endotube and situated where the pocket will be made. In this case the tissue expander has been placed in the sub-glandular position. Dr. Gottlieb will then begin to fill the tissue expander with either saline (or air) using an electric liquid pump. The tissue expander is filled approximately one and one-half times the desired end volume. The breast and connective tissues will slowly separate from the underlying muscle for sub-glandular placement or from the chest wall for sub-pectoral placement. Dr. Gottlieb may further situate the tissues with manual compression and by pushing the implant to each quadrant of the pocket. This will create an oversized pocket necessary for natural movement. After the tissue has been successfully expanded, the expander will be deflated and removed.
Dr. Gottlieb will then insert a long fill tube into an empty breast implant which will then be rolled up just as the tissue expander was.
After the implant has been rolled up it will then be inserted into the end of the endotube. This way the breast implant will be inserted and placed just as the tissue expander was.
After the breast implants have been positioned inside their respective pockets either under the pectoralis major muscles or, as in this case, in the sub-glandular position, Dr. Gottlieb will prepare to fill them.
Using a large syringe in combination with a closed delivery system, sterile saline is then injected into the breast implant. Dr. Gottlieb will take note of the cubic centimeter (cc) amount of sterile saline which will have been determined beforehand for your desired size goal. Your fill tubes may be left in until the last phase of the surgery.
Dr. Gottlieb will then elevate you to a sitting position to further determine if more saline is needed in either side and to check for symmetry and placement of the implants. If the amount of saline is correct the fill tubes are removed by a gentle but firm tug of the tubes and the implant valve is then sealed. If not, more saline is injected to create a symmetrical appearance. All patients have a degree of asymmetry although some may have more pronounced imbalances than others.
Dr. Gottlieb and his operating room staff will then perform an instrument and sponge check to determine that all items are accounted for and the incision lines are then sutured closed.
You are then possibly dressed in post-operative gear such as a surgical bra and possibly further wrapped in an ace bandage.
After you have been placed in your support garments the anesthesiologist will cease intravenous feed of the anesthetics and you are gently awoken and brought to the recovery area.
Breast Enlargement Before and After Pictures