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). |
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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. |
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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...
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