title: Transumbilical breast augmentation: a practical review of a growing technique.
abstract: BACKGROUND
  The transumbilical breast augmentation procedure has been described in the literature since 1993. This indirect route for implant placement has received both criticism and praise over the years, without a comprehensive assessment of the procedure from the perspective of the patient. The growing patient demand for the procedure, combined with the increased use by surgeons, prompts a review of the procedure and a discussion of its pros and cons, including tabulated patient satisfaction data.
  
  
  METHODS
  A retrospective chart review of 245 transumbilical breast augmentations performed by the second author from 2002 to 2004, including the 1-year patient satisfaction surveys, is presented. Additionally, complications from the procedure are also tabulated and compared with the complications published by our studies' dominant implant manufacturer in their 1-year follow-up published data. The patients were asked to rate their postoperative pain, numbness, firmness, size satisfaction, rippling, and overall satisfaction. Data were compiled and statistical analysis was performed using chi methods.
  
  
  RESULTS
  The study revealed a strong negative correlation between both the study parameters of prepectoral implant location and postoperative firmness and the survey result of overall satisfaction (P = 0.0041). Conversely, numbness, pain, and rippling, long felt to be linked to satisfaction, were shown to have no statistical correlation with satisfaction. A strong positive correlation with satisfaction was seen with retropectoral (submuscular) implant location. The complications from transumbilical breast augmentation in our study were hematoma = 1 (0.4%), umbilical wound infection = 8 (3.2%), deflation = 3 (1.2%), tunnel seromas = 5 (2.0%), asymmetry = 10 (4.1%), capsular contracture = 9 (3.7%), implant infection (0.0%). These complication rates were comparable or less than other published methods of breast prosthesis implantation.
  
  
  CONCLUSIONS
  Transumbilical breast augmentation is a safe and effective method for breast implant placement in selected patients. Patient satisfaction weighs heavily on implant location and postoperative firmness and less on other variables. The procedure is associated with a complication rate comparable with other methods and finds itself growing in demand and popularity secondary to high patient satisfaction.
authors.affiliation: Surgical Arts of Beverly Hills, Inc., Beverly Hills, California 90212, USA. Wab90210@aol.com
authors.forename: William A
authors.initials: WA
authors.lastname: Brennan
authors.forename: Jacob
authors.initials: J
authors.lastname: Haiavy
mesh_terms: D000293:Adolescent; D000328:Adult; D019928:Breast Implantation / Q000379:methods*; D004724:Endoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus / Q000601:surgery