Findings from a retrospective chart review of 3,300 consecutive transumbilical breast augmentation (TUBA) cases underscore the assertion of Robert A. Shumway, M.D., F.A.C.S., that TUBA is a faster, safer and better procedure than other breast augmentation approaches.

During the 27th annual American Academy of Cosmetic Surgery scientific meeting, Dr. Shumway reported on the complications, complaints and patient satisfaction ratings from TUBA procedures he performed between 1994 and 2010. Capsular contracture (69 cases, 2.09 percent) was the most common complication, although he notes the rate is lower than the published national average for augmentations performed via other routes.

There was one possible infection (0.03 percent), and only several other types of complications, all with rates equal to or less than 0.18 percent, he says, adding that there were no acute hematomas.

The single report of possible breast infection was an event that was diagnosed and managed with several doses of overnight IV cefazolin by another surgeon, Dr. Shumway says.

Four patients (0.12 percent) developed minor hypertrophic navel scars that were easily treated either with intralesional corticosteroid injections or by simple surgical excision and direct closure. Implant extrusion occurred in two patients (0.06 percent). One case involved a patient who presented four months after surgery with a self-induced breast skin injury that she allowed to fester and eventually erode into the breast, Dr. Shumway says.

"The patient never looked under her own homemade bandages," he says. Upon assessment of the situation, Dr. Shumway says he removed the exposed implant, cleaned the affected area and debrided the wound. After several months, the resulting lateral breast scar was eliminated by a large "O" to "T" local skin-flap closure. Months later, the patient underwent a unilateral TUBA to replace the removed implant.

The second patient reportedly consumed large amounts of abortion medication (morning-after pills) directly following her implant surgery. She also wore unsanctioned postoperative underwire bras directly against written medical orders, Dr. Shumway says.

Breast asymmetry occurred in six cases (0.18 percent), and size dissatisfaction presented in five cases (0.15 percent). "The key to happy patients and excellent breast symmetry is the notion of placing breast implants directly behind each nipple areolar complex. It is very important to first document any preoperative asymmetry by photography and then explain to patients that breasts are sisters, not twins," Dr. Shumway says, adding that the distinct possibility of postop asymmetry is included in every informed consent he obtains from patients. He says that patients must also give signed approval of their selected implant size after thorough consultation, and that there is a monetary charge for any future surgical size changes.

"Remember, if you feel there are two appropriate sizes, pick the larger size," Dr. Shumway says.

The results of the patient satisfaction ratings at two and six months after surgery were revealing, he says. Using a scale of one to 10, all two-month scores were eight or higher, with a 9.7 mean.

Dr. Shumway offers the following tips to cosmetic surgeons performing the TUBA procedure:

• Ask and specifically know about every OTC and prescription drug in the medical history of each patient, including products taken weeks before and weeks after surgery;
• Use a psychiatric screening system that includes a mechanism that reveals how a potential surgical patient feels about lawsuits;
• Avoid general anesthesia; use tumescent anesthesia;
• Always use the minimal touch techniques for handling implants;
• Teach patients to keep their superior breast implant surgical pockets open and mechanically instruct them how to "pinch and slide" the implant upward once a day;
• Provide quality postop care and see patients on postop day one and again at one week, or sooner if they are experiencing any discomfort.