Endoscopic Breast Augmentation: TUBA vs Transaxillary

Endoscopic breast augmentation is a minimally invasive method of placing implants through a small incision either under the arm or via the belly button. Only the transaxillary method is fully endoscopic, and our plastic surgery specialist wants patients to understand the differences before choosing an approach.

The TUBA method is limited to saline implants. It relies on a long tunnel from the belly button to the chest, so patients with minimal breast tissue face higher risks of rippling or visible edges. Because saline implants are firmer than silicone, they can also feel resistant to compression in slim patients. Silicone implants cannot pass through a TUBA tunnel.

TUBA is not fully endoscopic because the scope only helps locate the lower border of the pectoralis muscle. Once the scope passes that border, the critical division of the muscle cannot be visualized and the surgeon must bluntly tear the origin free, making symmetry difficult to control.

The transaxillary endoscopic technique allows either saline or gel implants. Approaching from the armpit gives direct visualization of the muscle origin, and the field of view can be better than the open method. Precise visualization lets the surgeon divide the muscle accurately instead of tearing tissue.

Transaxillary access also works for a wider variety of cases because the scope can reach both submuscular and subfascial planes. Patients with mild droop can benefit from biplanar techniques or gel implants for improved recontouring, and augmentation can even be combined with periareolar mastopexy when a lift is needed.

Because TUBA only places saline implants, patients should weigh the known pros and cons of saline versus silicone. Additional complications have been reported, including visible scar tunnels from the umbilicus to the breasts.

After evaluating both methods more than a decade ago, I found the transaxillary approach offered greater flexibility, precision, and scar control. I have used it for more than 20 years and continue to rely on the technique for endoscopic breast augmentation.