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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.