Hi, this is Dr. George Boris, and I’m going to demonstrate transumbilical breast augmentation – breast enlargement, putting the implants in through the belly button. I like this procedure, been doing now for 20 years, and I like the procedure because there are no cuts, no scars around the breast tissue itself. The incisions are hidden inside the belly button under the superior lip so there are no telltale signs.
The Benefits of Transumbilical Augmentation
I’ve had many women who actually had this done and we’re single, got married never told the husband they’ve had this surgery because it feels much more natural and there’s no telltale signs of any scars that reflected having breast surgery.
The patient I’m doing today chose her size. She wants to have 400 high-profile implants. What our job is, it is to determine what the patient wants, not what we want, and coach them. But intuitively most of the patients know what they want, so what our job is to find out what that is.
Dr.Boris’s Preparation
So it’s a 400CC high-profile implant that we’re gonna put in under the muscle. We put patients asleep generally, it could be done on IV sedation but in general, we like to put people to sleep under general. I have Dr. Rappaport here, he is the anesthesiologist.
Good morning!
He is monitoring the patient and I have a crew. I have Vanessa, my surgical nurse, and Stephanie who keeps account of the fluid we put in. We’re gonna use saline in this case. For this transumbilical breast augmentation, we use saline implants with a high profile, to me they feel they look the same as silicone.
What I gonna do now, I am gonna prepare a patient for the procedure. From the belly button area to the breast I’m going to make a tunnel, and so this is the direction the tunnel is going to be from the belly button. The typical dimensions of the pocket that we’re going to create in her case will be probably about seven and a half centimeters from the nipple down.
Most people are asymmetric and they don’t have identical twins but sisters – one breast is usually different than the other. I have to point that out in all patients so that they don’t wake up and say one breast is different because what we’re doing is enlarging what they already have in this person with this procedure.
This is the outline of where the pockets gonna be created, and to create the pocket I’m going to make an incision under the upper lip of the belly button that we closed with stitches that dissolve, so you don’t have to take them out. We simply go parallel to the skin, right under the skin of the breast, and then under the breast, and under the pectoralis muscle, and then once we make that track or that tunnel then we make a pocket and that’s over the ribcage and under the breast and under the muscle as you’ll see on both sides.
The Procedure
First I make my incision. Okay, so I’ve made my incision inside the belly button, under the upper lip and well you know you disguise, close with absorbable stitches that dissolve so we don’t need to take them out and that’s after.
Now what we’re gonna do is we made the incision we’re gonna create the tunnel and is a very safe procedure they’re simply sneaking this instrument under the skin, above the muscle. You can see it’s sneaking, it looks like an alien. You see it’s going up just under the skin, to the breast tissue.
I’m gonna lift the breast tissue, and the muscle, and we’re gonna go under at the breast tissue and a muscle. I’m under the muscle, you can see the muscle being tinted up and I’m above the ribcage obviously. So we’re under the breast, under the muscle on the left side and we’re gonna do the same on the right side now.
Sneak it under, parallel to the skin very safe there’s nothing you can injure, lifting up the muscle and the breast. I’m under the muscle and the breasts at the same time here. So now gonna follow the tunnel up under the breast, under the muscle and then sweep simply the muscle and the breast from the ribcage opening a pocket for the implant better than inserting.
So following this track under the muscle under the breast, I go then sweep way down to the base I created for the new implant to fit so that’s what I’ve done. I lifted up the muscle and the breast tissue off the ribcage creating my pocket and we are doing it on the other side.
Following at the track, under the muscle down to the base. I’m at the base of the breast which is gonna be where the inframammary fold will be. The fold separates the breast from the skin of the upper abdomen. So we’re gonna basically that’s the pocket that I’ve created on both sides that I’m gonna use to put the implants in.
Vanessa, my nurse already got everything ready for me. She gives the implant that’s rolled up like a cigar, deflated air is taken out of it and it’s been bathed in antibiotic solution. So we’re going to put it through the tunnel into the pockets that were created. Well, this is gonna be on the left side and then I am gonna do the right inside.
Okay it’s in, we have to do now is inflate it. So right now, we have a closed system where the fluid that we’re going to use to fill up the breast implant, it’s coming from an IV and from there it goes through tubing into a syringe. The special lock here redirects the fluid once it goes into the syringe when you push it out it goes through directed tubing that goes into the implants.
You know the implant is in. It is up to 400 CCS high profile. You’ll notice on the side there’s an indentation here, that’s where the nerve comes to the breast itself to give sensation and in my experience maybe 20% of patients have increased sensitivity and they like that. They say for that alone they’re happy to have the implants in, but in time this will stretch out. I don’t want to go in here and open it because you can injure the nerve and then affect the breast tissue which I don’t want to do obviously. So this is going to stretch out in the next month or so and expand, but so far it looks great.
So what do we have to do now, the implant is still connected to the tubing. You can see the tether to pull on it, on the tubing. You can see it’s still attached to the breast, so with little pressure, we’ll take it out, and the implant self-seals.
Now again Vanessa’s prepared everything, the implant is rolled up like this cigar, all the air is taken out of it, and it’s impaled on this instrument which I used to direct it into the pocket through the tunnel.
The Recovery From Transumbilical Augmentation
Now typically the recovery on this is one or two days. Typically patients get up they move around, and I’ve had four of my nurses over the years come back to work the next day. One was a bodybuilder and she was in Gold’s gym three days later doing bench pressing. So recovery is very quick because you’re not cutting through the skin, the breast tissue, the muscle simply going under all these structures, the muscle, or the breast tissue. For that reason alone, the typical complications you see a much less during transumbilical than the other techniques.
For instance, a capsule formation where it can become hard painful, and deformed is typically reported as ten percent of all breast tissue surgeries. In my experience with this technique, it is less than one percent. Once again you can see little indentation and that’s with the stretching where the nerve is coming to give the sensation to the nipple, and that’ll as time goes by expand and so you’ll have the more rounded appearance of the breast.
So a nutshell we’ve done, one breast in that I mentioned earlier in her case to was a little different, it’s an aerial is that different, and one’s a little lower but it’s just if she knows that and she’s happy and so she’s got a really beautiful breast now. The transumbilical is very safe, very quick, and probably in half an hour so she will be ready to go home.
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