How T.U.B.A. Surgery is Performed

Since T.U.B.A. is often performed in less than an hour, usually in approximately 30 minutes by most experienced surgeons, this procedure is most commonly executed under intravenous (IV) sedation, also sometimes referred to as Light Sleep/IV sedation or conscious sedation, and local anesthesia.  This anesthesia combination is twofold, (1) either by 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 Lidocaine/Marcaine and epinephrine into the treatment area.  The IV sedation drugs promote unconsciousness, loss of memory, immobility of the patient and interrupts specific autonomic responses such as rapid heartbeat, rapid breathing, etc..  The local injections provide pain relief and lessens 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 your surgeon, be marked for surgery and will 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 to visualize and understand where these markings will be placed.  Some surgeons will mark their patients after they have been sedated rather than before; this is purely a preference as both are accepted.

 


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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 an endotube which will be used to tunnel from the umbilicus to the breasts.  Blunt dissection is used to separate the fat and skin from the muscle fascia from the navel entry point to beneath a predetermined point underneath the breasts.  

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After both tunnels are created, the 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 is also possible with T.U.B.A.  If sub-pectoral placement is desired, the endotube is further inserted under the pectoralis major to bluntly dissect it away from the chest wall and pectoralis minor.  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.

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, your surgeon 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 placed tunnel.

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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, as depicted at the left, will be rolled up on both sides so that it will easily fit within the endotube.  There will be a long fill tube attached to the valve through which it will be inflated.  
The tissue expander will be pushed through 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 either saline (or air) using an electric liquid pump for saline or large syringe for either

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Continued...

       

All Information Use Allowance © 2002-2006 solely to Leonard Grossman, M.D., P.C.
Diagrams: Copyright © Gerald Johnson, M.D.
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This page was last updated: 04/24/2007