By Terrye Tebbetts
The umbilical incision
Umbilicus is the medical term for your belly button. The incision for the umbilical approach is placed in and around the belly button. I use the terms “in” and “around” because, to some degree, the location of the incision depends on the size of the belly button. Most women’s belly buttons are small, and the incision required is one inch or more in length. The surgeon may not make the initial incision one inch, but the instruments required for the operation usually stretch the incision, and portions of the incision can sometimes extend outside the boundaries of the belly button.
The main advantage of the belly button incision is that it is located off the breast. The belly button incision sounds very acceptable to many women because they are familiar with other endoscopic procedures in the abdomen that use similar incisions, such as ligation of the fallopian tubes (tubal ligation). Actually, the incision required to insert the breast implants through the umbilicus is much larger than that required for many abdominal procedures.
The main advantage of an incision in and around the belly button is that the incision is located off the breast.
The main disadvantages of the umbilical incision compared to other incisions are:
• It offers the surgeon the least direct vision and control compared to other incisional locations and, therefore, the least predictable results.
• It is located farther from the breast, and more normal tissues must be traversed enroute to the implant pocket, increasing tissue trauma, potential pain and bleeding, and recovery time.
Access to the breast is created by bluntly pushing a one inch-diameter tube from the umbilicus to each breast through the tissues of the upper abdomen.
The pocket for the implant is developed by inserting an uninflated implant, blowing it up, then pushing it vigorously side to side to tear a pocket to receive the implant. The surgeon cannot see inside the pocket to create the most precise pocket with the least bleeding.
When the pocket is created by any method other than direct vision, the pocket is less accurate, bleeding is potentially increased, control is less, and tissue trauma is potentially greater.
Most surgeons who use the umbilical approach do not offer implant placement behind muscle. If you are thin, dual plane or traditional behind muscle is better long term.
Precise dual-plane pocket development and pectoralis muscle positioning is currently not an option if the umbilical approach is selected. No currently published studies indicate that patients having augmentation via the umbilical approach can routinely experience comparable recovery to the inframammary and axillary approaches we have published.
The umbilical approach is not ideal for reoperations to correct postoperative
complicatioins or problems because it limits a surgeon’s direct vision and control. A second incision, usually inframammary may be required to address postoperative problems or complications. Although it is technically possible to treat an excessively tight capsule (capsular contracture) via the umbilical approach, the inframammary approach affords the surgeon much more control of capsule removal, more complete removal of capsule, and better control of bleeding.
So why would anyone want to use this approach? It sounds good, until you really look at it objectively. Does this mean that you can’t get a good result through this incision? No. It just means you should be able to expect an even better result in the same patient through an axillary approach, with a faster recovery by avoiding additional tissue trauma when passing through the abdominal tissues and avoiding blunt, blind dissection. The armpit incision satisfies the advantage of moving the incision off the breast. The armpit incision is much closer to the breast, so much less normal tissue is traumatized getting to the breast, and the risk of depressions or troughs in the abdomen from bluntly pushing a large tube through the fat are avoided. From the armpit, the entire pocket can be created precisely and bloodlessly under direct vision for a more accurate, more controlled pocket with less bleeding. Your surgeon can also easily place the implant above or below muscle via the armpit, depending on your tissue needs.
Why would any surgeon want to use the umbilical approach? The umbilical approach allows some surgeons to differentiate themselves from other surgeons by advertising: “I can do it, and they don’t. Come to me.” The umbilical approach can be appealing from a marketing perspective, but I challenge any surgeon to debate me in a scientific forum on the logic of why it is really better. There is no scientific study that indicates that recovery (the best indicator of tissue trauma and bleeding) after umbilical augmentation can compare to the twenty-four hour return to normal activities we have confirmed for patients via inframammary, periareolar, and axillary approaches. We have many patients who are interested in umbilical augmentation—until they learn the facts and compare recovery to the other approaches. As long as surgeons are performing umbilical augmentations using blunt, blind dissection techniques, the umbilical approach offers no comparison to other approaches if precision, control, minimal tissue trauma and bleeding, and the most rapid recovery are objectives. In fairness, I hope that one day the umbilical approach will be able to offer the same level of control as other approaches and avoid unnecessarily traumatizing a normal area of the body (the abdomen) to get to the breast. When it can, and when a surgeon can create the pocket without using blunt, blind dissection, I’ll be happy to endorse the approach. We can always use more options—provided they make sense.
About the Author: Terrye Tebbetts is one of the most knowledgeable women in the world about breast implants, with 27 years of experience educating patients and 11 years as a patient herself. For more information about breast implants or breast augmentation Dallas surgeons, please visit www.thebestbreast.com.