Beverly Hills Trans-Umbilical Augmentation
PROS AND CONS (TRANS-UMBILICAL AUGMENTATION)
In my practice, having performed thousands and thousands of breast enhancement surgeries, I found that safety and predictability are of utmost importance in achieving excellent results in breast augmentation surgery. I have seen countless numbers of patients who have undergone the trans-umbilical augmentation mammoplasty procedure, many with unsatisfactory results. My concerns with this approach are the predictability and positioning of the implants. Placing an implant at the umbilicus through a trocar under the muscle can be extremely difficult for any talented surgeon. Obtaining cleavage, releasing of the parasternal attachments of the pectoralis major muscle and operating on patients who have any degree of skin laxity or ptosis may lead to a very unnatural appearance to the breasts using the trans-umbilical approach. I personally do not use this approach and have done a significant number of breast revision surgeries on patients with double-bubble deformities, malpositions and severe bottoming out. My favorite approach is the periareolar approach with the incisions made under the areola and the implant is then placed subpectoral in the dual plane technique. The parasternal attachments of the pectoralis major muscles are easily and predictably released and thereby the implants are positioned in a correct pocket. Also, lateral dissection beyond the lateral board of the areola can be more easily performed with less lateral malposition of the implants leading to poor cleavage.
In summary, I do not favor trans-umbilical augmentation mammoplasty procedure. Although it may had a scar on the umbilicus and there may be no incision site on the chest wall, I do not believe it is worth the tradeoff of difficulty in obtaining perfect positioning of the implants, perfect release of the muscle and preventing lateral displacement of implants due to improper release of the lateral breast tissue through a trocar.