How T.U.B.A.
Surgery is Performed
Since T.U.B.A. is often performed in less than one hour, usually in approximately 20 to 30 minutes by the most experienced surgeon - Dr. Grossman, this procedure is most commonly executed under intravenous (IV) sedation, also sometimes referred to as Light Sleep (Twilight), IV sedation or conscious sedation, combined with local anesthesia. This anesthesia consists of two parts, (1) intravenous injection or through an intravenous drip system of a sedating drug meant to cause a light sleep, hence the name, and (2) injections of dilute Lidocaine/Marcaine mixture and epinephrine into the treatment/surgery area. The IV sedation drugs promote sleep, loss of memory, immobility and ability to feel pain, etc.. The local anesthesia provides additional pain relief and decreases the chance of bleeding in the incision or dissection areas by constricting the blood vessels.
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Just before your surgery, you will speak with Dr.Grossman, get marked for surgery and then 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.
The diagram to the left and photograph to the right will further help you visualize and understand where these markings will be placed. |
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After you have been sedated, prepped and stabilized your surgeon 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). |
| He will then insert a tunneling device which will be used to tunnel from the umbilicus to the breasts. Blunt (no cut technique) dissection is used to separate the fatty tissues from the navel entry point to a predetermined point underneath the breasts. |
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After both tunnels are created, the tunneling device or an 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 however is more preferred with T.U.B.A. If sub-pectoral placement is desired, the endotube is further inserted under the pectoralis major muscle to bluntly dissect it away from the chest wall and pectoralis minor muscle. 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 and there is less breast droopiness in the future |
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. Grossman 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 created implant pocket.
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After the tunnels have been successfully created either above or below the pectoral muscle, the endoscope is removed. Next, a tissue expander (basically a balloon with an attached tubing), as depicted at the left, will be rolled up on both sides so that it will easily fit within the front of the endotube. There will be a long fill tube attached to the expander so that it can be inflated. |
| The tissue expander will be pushed by the endotube and situated where the pocket will be made. In this case the tissue expander has been placed in the sub-glandular position. Your surgeon will then begin to fill the tissue expander with saline using an electric, liquid pump. |
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