Transumbilical Breast Augmentation Research Articles

Advantages and Disadvantages of Breast Augmentation: Surgical Techniques, Outcomes and Future Directions.

Breast augmentation remains a highly sought-after cosmetic surgery, with various techniques available to enhance breast size using implants or fat transfer. This systematic review, spanning studies from 2003 to 2024 and adhering to PRISMA guidelines, evaluates the outcomes of different surgical approaches concerning scar quality, postoperative pain, patient satisfaction, and complications. The periareolar technique emerges as a favorable option, offering minimal postoperative pain, high patient satisfaction, and precise surgical control with subtle scarring. Transumbilical breast augmentation (TUBA) is noted for its scar-free approach, resulting in low pain and high satisfaction, though it requires specialized training and cannot use prefilled implants. The review highlights the varying complication rates across techniques: modern silicone implants, while safer than earlier injectable materials, still face risks such as rupture and capsular contracture. Autologous fat grafting is generally safer but can lead to issues like erythema and abscesses. The use of effective acellular dermal matrix (ADM) is linked to higher rates of seroma and infection compared to non-ADM procedures, although sterile human ADM shows a lower risk profile. The study underscores the importance of personalized surgical planning to optimize outcomes, as each technique offers distinct benefits and challenges. The findings suggest that future research should aim to refine these techniques and address their associated complications to further enhance patient satisfaction and surgical outcomes in breast augmentation.

Transumbilical Silicone Breast Augmentation: A 13-Year Experience and 5-Year Analysis.

Transumbilical breast augmentation (TUBA) with saline implants has been considered a safe and efficient technique for decades. However, because silicone implants are more popular than saline ones, TUBA with saline implants is not widely performed. In 2014, we published a report on transumbilical breast augmentation using silicone cohesive gel implants. As we have performed transumbilical silicone breast augmentation (TUSBA) for 13 years with slight modifications, this study aimed to describe this novel technique and present accompanying patient outcomes over 5 years. We enrolled patients desiring breast augmentation at a single center. The preoperative design was initially determined with the patients in standing positions before they underwent surgery under general anesthesia in a supine position. Between January 2018 and December 2022, 69 women and one man underwent TUSBA at a single center. All patients underwent cohesive gel silicone implantation in the subpectoral pocket. The implant size varied from 225 to 300mL (average 272mL) because two patients underwent surgery with implants of different sizes due to breast asymmetry. All patients were satisfied with the surgery outcome except one who was dissatisfied because of abdominal bulging. TUSBA offers advantages such as minimal scarring and unrestricted arm movement; thus, it can be an alternative option for patients seeking breast augmentation. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Transumbilical Silicone Implant Breast Augmentation.

In transumbilical breast augmentation (TUBA) with prefilled silicone implants, technical challenges remain to accommodate more implant options and dissection planes. The authors aimed to demonstrate the feasibility of TUBA using various types of prefilled silicone implants (TUSBA) and its applicability for subglandular, subfascial, dual-plane implantation. In the early stage, TUSBA was primarily performed using endoscope-assisted blunt dissection, and later converted to full endoscopy dissection to achieve better results. An endoscope was used to confirm the pocket and check bleeding for both groups. For the endoscope-assisted group, surgical techniques were modified from conventional TUBA. In full endoscopy TUSBA, the entire dissection process was performed under endoscopic monitoring. Preliminary data of patients undergoing TUSBA from June of 2016 to April of 2021 were retrospectively reviewed. Breast implants with smooth, textured, or nanotextured surface properties and round or anatomic shapes were used, with sizes up to 500 mL. Seventy-four patients with a mean age of 36.4 years (range, 21 to 55 years) were enrolled in this study. Follow-up ranged from 1 month to 4.5 years (mean, 15.6 months). No excessive postoperative pain in breast or abdomen was reported. Surgery outcomes were aesthetically pleasing in both groups. In the endoscope-assisted group, 3 patients (4.6%) required major revisional procedures. No revision was required in the full-endoscopy group. TUSBA with various types of silicone implants is feasible and accommodable to all dissection planes. The full-endoscopy technique is helpful in reducing the higher complication rate. Therapeutic, IV.

Transumbilical Silicone Breast Augmentation: A Practical Review of an Innovative Technique.

Transumbilical silicone breast augmentation (TUSBA) is a fairly new and rapidly growing technique of endoscopically assisted placement of silicone breast implants. In comparison, the well-known transumbilical breast augmentation (TUBA) with saline has been described in the literature since 1993 (Planas J. Introduction of breast implants through the abdominal route. Plast Reconstr Surg. 1976;57:431-437). The TUBA procedure has proven to be safe, efficient, and cosmetically sound over the last 29 years (Shiffman MA, Caleel RT, Shumway R, et al. Survey of transumbilical breast augmentation (TUBA). Am J Cosmet Surg. 2011;28:5-11). Augmentation with silicone through the umbilicus is becoming more popular due to several factors: first, because the acceptance of TUBA with saline has been good with positive outcomes and, second, because patients prefer the discrete location and small size of the umbilical scar left behind. Endoscopic guidance is a critical tool for learning and visualization and for reducing complications such as hematoma or misplacement of the implant.Breast augmentation continues to grow in popularity and acceptance, alongside cosmetic procedures in general. This author expects that, as the TUSBA technique becomes more widespread in use, surgeons will benefit from having a practical clinical publication from which to modify their own technique. This publication will present the authors' TUSBA technique and chart review of practice data from May 2021 through November 2022, wherein the TUSBA procedure was performed.Forty women aged 21 to 61 years (mean, 35.13 years) underwent endoscopically assisted TUSBA. All patients had the implants placed in the submuscular pocket. Patient surveys and postoperative visit data were used in the generation of follow-up information. Upon inspection of the chart data at 3, 6, 9, and 12 months, there were no reports of capsular contracture. Transumbilical silicone breast augmentation is a safe and efficient method for silicone implant placement in select patients.

Our Experience With Transumbilical Breast Augmentation: Largest Published Series to Date With 2263 Patients

Transumbilical Breast Augmentation (TUBA) represents a unique approach for breast augmentation (BA). The endoscopic-guided procedure allows for placement of saline breast implants above or below the pectoralis major muscle without placing any incisions on or near the breast. The procedure has not been widely adopted likely due to the high learning curve and the need for advanced endoscopic skills. In addition, silicone implants have increasingly become more popular than saline implants for multiple reasons over the years, which has naturally decreased the number of TUBA cases. Here, we present the largest series of TUBA cases performed at a single institution and present our standardized reproducible technique to promote wider application of TUBA in Cosmetic Surgery. This is a single-institution retrospective study that included 2263 patients (4526 implants) between 1994 and 2017. All cases were performed under tumescence anesthesia with monitored intravenous sedation. Operating time, conversion to another approach, early and late complications, and patient satisfaction were studied. Our data were compared with the available studies via an extensive literature review. In total, 2263 patients (4526 implants) were included in the study. There was 1 case that required unilateral intraoperative conversion to periareolar approach in the initial experience for technical difficulty. Five small postoperative hematomas occurred that were successfully treated with conservative management and did not require evacuation, and 4 out of 5 postoperative hematomas occurred in subpectoral BA and 1 occurred in subglandular BA. Average operating time was 45 minutes. Remote Grade III and IV capsular contracture occurred in 113 patients requiring capsulectomy through periareolar approach. There were 3 cases of superficial umbilical wound infection that occurred, 1 in subglandular BA and 2 in subpectoral BA. These cases were treated with oral antibiotics and local wound care. No implant infection occurred. There were 32 cases of mild asymmetry that were acceptable by patients and did not require a revision, 19 cases occurred in the subpectoral BA group, and 13 cases occurred in the subglandular BA group. The procedure yielded a very high satisfaction rate. TUBA is a safe and reproducible procedure for BA with short operative time, high patient satisfaction, and comparable outcomes with other approaches.

Lubricating the Insertion Funnel with Autologous Fat Tissue for Inserting Breast Implants.

During the procedures of breast augmentation or reconstruction, to smoothly insert a breast implant into the implant pocket without much resistance is a challenge. The surgeon has to avoid forcefully squeezing the implant and meanwhile to adopt “no touch” technique.1 One of the devices to overcome the issue is the Keller Funnel. However, it is still problematic to use the Keller Funnel for inserting a textured implant because of the highly adherent surface.2 Additional lubricants are usually applied, for example, lidocaine hydrochloride 2% jelly or EMLA cream.3 But these lubricants are used off-label, and potential allergy reaction or foreign body reaction raises a concern of safety.4 Furthermore, because Asian women usually ask for small surgical incisions due to their tendency of developing scar tissue and hyperpigmentation, transaxillary or transumbilical breast augmentation is preferable.5 Obviously, the transaxillary or transumbilical approach requires a longer distance between the surgical incision and the implant pocket. These demands much increase the challenge of smoothly inserting the implants. Therefore, we introduced an easy technique to use autologous fat tissue as lubricant for the Keller Funnel to facilitate inserting breast implants. Patients were placed in supine position for receiving general anesthesia. Based on the planned approach, implant pocket was prepared as a standard protocol. Then, autologous fat tissue was harvested with the use of a tumescent technique. The site of fat harvesting could be flexibly determined by the patient’s needs. Before liposuction, the harvest site was infiltrated with 50 ml of tumescent fluid, which was prepared by adding 10 ml lidocaine (2%) with epinephrine (1:50,000), 5 ml sodium bicarbonate (7%) in 500 ml Lactated Ringer solution. Liposuction was performed with a 3-mm aspiration cannula, which was connected to a low pressure suction system (50 kPa). The lipoaspirate and tumescent fluid were kept in the syringe. Further fat preparation was not necessary to avoid contamination. Approximately 15 mL of lipoaspirate was sufficient to lubricate each funnel and pocket. The next step was to cut the Keller Funnel to the appropriate tip diameter and to hydrate the funnel as in the manufacturer’s instructions. Before pouring breast implants into the funnel, the lipoaspirate was squirted from the syringe into the insertion funnel and the pocket for lubricating (Figs. 1, 2). The following procedures were the same as the standard protocol including placing the funnel tip inside the implant pocket, propelling the implant into the pocket, checking the implant position, and closing the wound.Fig. 1.: Squirting the autologous fat into the Keller Funnel for lubricating.Fig. 2.: Pouring the breast implant into the Keller Funnel, which has been lubricated by autologous fat.There has been a large amount of evidence addressing the safety of autologous fat grafting, as it has been increasingly used in cosmetic breast augmentation. The use of autologous fat to lubricate the insertion funnel is an easy technique for smoothly inserting breast implants and is free from the risk of foreign body reaction and allergy. The technique could be combined with any insertion devices and applied in any approaches of breast augmentation or reconstruction.

Augmentation Mammoplasty With Silicone Implant Using Transumbilical Approach at a Subpectoral Level

Endoscopic placement of breast implants has been described through an umbilical incision. Limitations include the fact that only inflatable implant can be used through umbilical approach. The purpose of this study is to describe the authors' evolutionary transumbilical technique with cohesive silicone gel implant insertion and to retrospectively analyze preliminary results. The authors' technique is the placement of a cohesive silicone gel implant using a transumbilical approach in a subpectoral plane. Patients who were selected had mammary hypoplasia without ptosis and who requests breast augmentation with a scarless and natural feel breast were considered candidates. The technique and indications are presented thoroughly. From June of 2011 to January of 2012, 42 women aged 23 to 46 years (average, 31.6 years) underwent the endoscopic transumbilical breast augmentation. All patients had round silicone implants placed in the retropectoral pocket location. The results of this study indicate that transumbilical technique is highly successful. Complication included transient periumbilical bulging (5 patients, 11.9%), hypertrophic scar needing revision (1 patient, 2.3%), and conversion to other breast incision due to capsular contracture (3 of 84 breasts, 3.5%). Transumbilical breast augmentation with prefilled implant is a safe and attractive technique for breast implant placement in selected patients. With this inventory modification, the result can permit surgeons expanded spectrum of implant selection for transumbilical approach.

Revisiting Triple Antibiotic Irrigation of Breast Implant Pockets: A Placebo-controlled Single Practice Cohort Study.

Background:Capsular contracture is the most common complication following primary augmentation mammoplasty. It remains poorly understood but is attributed to subclinical infection, immunologic response to breast implants, and chronic inflammatory changes caused by the presence of the implants. The infectious theory of contracture has lead to the practice of irrigating implant pockets with a triple antibiotic solution. The purpose of this study was to determine if antibiotic irrigation reduced the incidence and severity of capsular contracture compared with saline irrigation.Methods:A cohort study enrolling all patients having undergone primary augmentation mammoplasty performed by surgeon A and surgeon B between 2011 and 2012 for all women satisfying inclusion and exclusion criteria was conducted. The only difference in surgical technique was the use of antibiotic irrigation by surgeon B. A chi-square test and analysis of variance with predetermined 95% confidence intervals were performed.Results:Fifty-five patients were operated on. Twenty-eight of surgeon A’s patients were included, ranging in age from 22 to 50 with a mean follow-up time of 1.8 years. Twenty-seven of surgeon B’s patients were included, ranging in age from 22 to 56 with a mean follow-up time of 1.6 years. Rate of capsular contracture was 3.6% (surgeon A) and 3.7% (surgeon B). Chi-square statistic was found to be 0.0014 (P = 0.97) and analysis of variance F value was 1 (P = 0.39).Conclusions:Triple antibiotic breast irrigation is not associated with a significant reduction in the incidence or severity of capsular contracture compared with sterile saline when high-quality surgical technique is used.

Survey of Transumbilical Breast Augmentation (TUBA)

Transumbilical breast augmentation (TUBA) has been used for at least the past 17 years as an alternative to other approaches for augmentation. There are essentially few articles that have included the possible risks and complications and their rate. This study, using a form, was done to collect as many cases as possible to determine the type of TUBA procedure used and the rate of some of the possible complications. A total of 5073 cases were reported and the statistics evaluated.

Transumbilical Breast Augmentation with Adjustable Saline Breast Implants: A Novel Approach to Breast Asymmetry

Objective: To investigate the novel use of adjustable saline breast implants via the transumbilical approach for breast asymmetry. Methods: A retrospective review of medical records of 8 patients who underwent breast augmentation via the transumbilical approach utilizing the adjustable saline implant. Variables reviewed included age of patients, reason for procedure selection, mean number of postimplantation volume changes, range of volume change, and follow-up time. Results: The patients' mean age was 26.3 years. The most common reason for selection of adjustable saline implants was breast and chest wall asymmetry. The mean number of postimplant volume adjustments was 1.33, with a mean addition of 32.5 mL (range of −20 mL to −150 mL). Mean follow-up time was 8 months. Conclusion: Transumbilical placement of adjustable saline breast implants is a reliable technique for use in cases of asymmetry, avoiding scars on the breast and maintaining a remote insertion site.

Transumbilical Approach for Pseudogynecomastia Liposuction

Pseudogynecomastia, a common phenomenon caused by increased male breast subcutaneous fat deposition, usually occurs bilaterally. The development of pseudogynecomastia may cause significant psychological distress and embarrassment, particularly in young men and adolescents. Unfortunately, pseudogynecomastia responds poorly to diet and exercise. For this reason, surgery is the first-line treatment. Liposuction (using a vacuum-suction cannula) via the axillary approach usually is recommended [1]. Liposuction provides a well-defined contour for the male breast with small axillary scars. However, even after successful operations, this approach could leave visible postoperative skin scars. To avoid these axillary scars, we have used a transumbilical approach for pseudogynecomastia liposuction, as in transumbilical breast augmentation (TUBA). Using the transumbilical approach, we make only one vertical incision inside the umbilicus at the 12 o’clock position and remove the fatty tissue with a traditional tumescent liposuction (Fig. 1). Tumescence is accomplished using one ampule of adrenalin (1 mg.) per liter of infiltrated isotonic saline solution. The cannulas most often used are 3 and 4 mm in diameter and 30 to 35 cm long. The liposuction is always performed starting in the deep plane and ending in the superficial plane using the thinnest stems. The umbilical incision is closed with 5-0 nylon stitches. After liposuction, all the patients are wrapped with compressive bandages for 6 weeks to improve contraction of the skin. The advantages of the transumbilical approach are the easy access it provides to both breasts with only one incision. Furthermore, it permits a more comfortable position for the surgeon and leaves a small and inconspicuous skin scar inside the umbilicus, eliminating the stigma of breast surgery. We have used this approach for 10 patients with mild to moderate pseudogymecomastias, and none of the patients had postoperative complications. There were no treatmentinduced asymmetries, contour deformities, or irregularities (Fig. 2). No open excision or skin reduction procedures were required. Tumescent liposuction using a single entry site inside the umbilicus is a new access for the treatment of pseudogynecomastia, resulting in a high level of patient satisfaction.

Transumbilical breast augmentation with insertion of saline-filled breast implants

Objective To evaluate the surgical technique and procedures of transumbilical breast augmentation with an inverse U-shape incision and insertion of saline-filled breast implants. Methods With specialized instruments, the subcutaneous tunnel was undermined to the inframammary crease after inverse U incision made along the umbilical border. The subpectoral space was dissected with a dissector after the advancement of obturator across the inframammary crease. The expander was inserted into the subpectoral pocket to be filled to obtain the high degree of symmetry of the breasts. Finally, the previously prepared implants were inserted after the expander deflated and removed. Results All patients gained satisfactory results with no complications, such as hematoma, infection, implant deflation and Baker III or IV capsular contracture. Conclusions Breast augmentation could be performed through umbilical incision with the usage of saline-filled breast implant. This is an alternative of incisions in breast augmentation. Key words: Umbilicus; Augmentation mammoplasty; Breast implants; Endoscope

Transumbilical Breast Augmentation Is Safe and Effective

Transumbilical breast augmentation (TUBA) has proved to be safe and effective. This article highlights the advantages, disadvantages, gives an overview of the technique, discusses complications, and provides factual information to counter false negative information about the procedure.

Transumbilical Breast Augmentation

The transumbilical breast augmentation procedure has been described in the literature since 1993. This indirect route for implant placement has received both criticism and praise over the years, without a comprehensive assessment of the procedure from the perspective of the patient. The growing patient demand for the procedure, combined with the increased use by surgeons, prompts a review of the procedure and a discussion of its pros and cons, including tabulated patient satisfaction data. A retrospective chart review of 245 transumbilical breast augmentations performed by the second author from 2002 to 2004, including the 1-year patient satisfaction surveys, is presented. Additionally, complications from the procedure are also tabulated and compared with the complications published by our studies' dominant implant manufacturer in their 1-year follow-up published data. The patients were asked to rate their postoperative pain, numbness, firmness, size satisfaction, rippling, and overall satisfaction. Data were compiled and statistical analysis was performed using chi methods. The study revealed a strong negative correlation between both the study parameters of prepectoral implant location and postoperative firmness and the survey result of overall satisfaction (P = 0.0041). Conversely, numbness, pain, and rippling, long felt to be linked to satisfaction, were shown to have no statistical correlation with satisfaction. A strong positive correlation with satisfaction was seen with retropectoral (submuscular) implant location. The complications from transumbilical breast augmentation in our study were hematoma = 1 (0.4%), umbilical wound infection = 8 (3.2%), deflation = 3 (1.2%), tunnel seromas = 5 (2.0%), asymmetry = 10 (4.1%), capsular contracture = 9 (3.7%), implant infection (0.0%). These complication rates were comparable or less than other published methods of breast prosthesis implantation. Transumbilical breast augmentation is a safe and effective method for breast implant placement in selected patients. Patient satisfaction weighs heavily on implant location and postoperative firmness and less on other variables. The procedure is associated with a complication rate comparable with other methods and finds itself growing in demand and popularity secondary to high patient satisfaction.

Optimizing the Transumbilical Breast Augmentation: The 8-Year Experience of a Single Surgeon and 150 Patients

Introduction: Since Johnson and Christ first formally described the transumbilical approach to breast augmentation in 1993, the procedure has been constantly evolving. Some surgeons have embraced this new technique and incorporated it into their daily practice, whereas others have remained skeptical of their ability to create lasting and reproducible results with this technique. This article is not meant to defend the use of transumbilical augmentation or to describe the stepwise approach to conducting the surgery. Instead, to help further optimize this procedure for both the patient and the surgeon, we address surgeons who are currently performing the procedure and review the subtleties that a single surgeon has developed over the past 8 years. Materials and Methods: We discuss relative indications and contraindications to performing this surgery on particular individuals and body types and review the alterations that a particular surgeon has incorporated into his practice of transumbilical augmentation, including the use of tumescent fluid for dissection of the abdominal tunnels and the implant pocket, as well as elimination of the endoscope and tissue expanders from his standard practice. We describe his use of muscle relaxants, nitroglycerin, and zafirlukast in his patients' postoperative care. Results: Over the course of the past 8 years, this senior surgeon has performed more than 150 transumbilical breast augmentations. The results of these surgeries have been consistent satisfaction for the patients and the physician. The surgeon has not observed an increased incidence of complications with this procedure as compared with his other approaches. Discussion: It is our contention that the transumbilical breast augmentation is a viable alternative approach and continues to evolve in its technique. As individual surgeons review their experiences and discuss their refinements, this procedure will continue to become more accepted by surgeons and patients alike.

Transumbilical breast implant replacement

Background The transumbilical approach to breast augmentation has been described in the plastic surgery literature. However, the replacement of failed implants by way of the transumbilical approach has not been fully described. Objective This article reports the instruments and surgical procedures used in breast implant replacement by way of the transumbilical approach. Methods The initial operative steps for transumbilical breast implant replacement are identical to those previously described for transumbilical breast augmentation. However, instead of advancing the Johnson obdurator deep to the breast on the muscle or chest wall, as in the original procedure, it was elevated away from the chest wall with pressure sufficient to maintain contact with the capsule. A cutting cautery was used to open the capsule. The implant was punctured and nearly evacuated, and the position and orientation of the most accessible fold were assessed endoscopically. An endo-grasper was used to grasp the implant, which was then withdrawn. The interior of the pocket was examined and endoscopic capsulotomy was performed, if necessary, before insertion of the new implant. Results Transumbilical breast implant replacement, including size decrease and modest size increase, has been performed on 28 breasts with no complications. Conclusion Although primary transumbilical breast augmentation should be performed only by surgeons who have taken a formal training course, those surgeons who are already familiar with primary transumbilical augmentation can safely perform implant replacement by way of the navel without additional training.

Keeping the transumbilical breast augmentation procedure safe.

The transumbilical breast augmentation procedure has proved to be highly effective and safe when performed properly, as outlined herein. In the author's opinion, the popularity of the procedure will continue to increase among both surgeons and patients. This article focuses on the steps necessary to maximize the continuing safety of the procedure. The three most critical points are that no sharp instruments are used, the surgeon's handling of the instrument prevents any long thrusts, and at no time does any instrument point toward the abdominal or thoracic cavity. These and numerous other safety tips are presented here.

Experience with transumbilical breast augmentation.

Transumbilical breast augmentation (TUBA), an endoscopicassisted procedure in which saline breast prostheses are inserted through the umbilicus, is a patient-driven, frequently performed procedure that remains controversial. The author describes the operative technique and results in 90 patients who underwent TUBA between October 1996 and July 2000 by the same surgeon in a community practice. A total of 85 patients underwent submammary TUBA and 5 patients underwent submuscular TUBA. Seventy patients were available for follow-up. Postoperative results of the 70 patients were graded as very good in 56 (80%), good in 12 (17%), and fair in 2 (2.9%). Complications were conversion to an open approach in 1 patient and an accidental submuscular entry into the pocket in 1 patient. There were four capsular contractures (5.7%), 5 patients (7.1%) were reoperated: 2 for capsulectomies, 1 for implant buckling, 1 for scar revision, and 1 for removal of the implants. There were no implant ruptures, hematomas, or infections. Advantages of TUBA include minimal scarring, remote incision, short operating time, low capsular contracture rate, and rapid recovery. These results of this evolving procedure suggest that in select patients TUBA provides a high level of patient satisfaction and low complication rates. As TUBA techniques for submuscular placement continue to develop, more patients may become TUBA candidates.

Transumbilical Breast Augmentation

Surgical augmentation has been performed since 1899, with varying results. Recent developments in endoscopic instrumentation have enabled surgeons to perform many types of procedures through small incisions located at a distance from the surgical site. The transumbilical breast augmentation (TUBA) has advantages over other methods, including a quicker recovery, less pain, and lower chances of complications. This article familiarizes perioperative personnel with TUBA and how to care for the patients who undergo this procedure.

Trans-umbilical breast augmentation (TUBA): Technique for pre-pectoral and post-pectoral placement of implants

The trans-umbilical breast augmentation (TUBA) procedure, a technique for inserting inflatable breast implants through an incision in the umbilicus or through preexisting abdominal scars, adds a new dimension to breast augmentation surgery. The technique is relatively easy to learn and requires few specialized instruments. Surgical time is considerably less, implants can be placed in the subglandular or submuscular position, and patient satisfaction is very high with this approach.