title: Maximizing the use of abdominoplasty incision in oncoplastic and aesthetic breast surgery: four transabdominal (transumbilical-like) augmentations.
abstract: BACKGROUND
  The transabdominal (transumbilical [TUBA]) procedure for breast implant insertion is known for aesthetic aims, but cosmetic and psychosocial improvements reported in aesthetic surgery should be transferred to breast reconstruction patients.
  
  
  METHODS
  Surgical and psychological aspects were analyzed in four cases through clinical evaluation and psychosocial assessment. Three patients were candidates for postmastectomy reconstruction by transverse rectus abdominis myocutaneous (TRAM) flap, and one patient was a candidate for cosmetic abdominoplasty. The expectations of the patients were met, and body image improvement was provided through contralateral breast augmentation in all cases. Details of the surgical approach focused on the inframammary fascial system. The psychosocial implications of the TUBA-like breast augmentation combined with the abdominoplasty procedure were emphasized through the analysis of the technical details and the psychological behaviors affecting the surgery.
  
  
  RESULTS
  The result, after long-term clinical follow-up (37 months) and administration of a satisfaction questionnaire (CSQ-8), established the importance of scarless surgery to healthy breast tissue and the positive reception by women with different life histories.
  
  
  CONCLUSIONS
  This report concerns only a few potential patients, but supports a trend that surgeons should consider. An elective indication for transabdominal breast augmentation can be represented even by those few patients who are candidates for TRAM flap reconstruction, who are agreeable to a small augmentation in the absence of a scar on their healthy breast, and whose reconstructed breast is larger and more prominent at the central part of the mound than on the contralateral side.
authors.affiliation: Department of Plastic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, via Venezian 1, Milano 20133, Italy. egidio.riggio@istitutotumori.mi.it
authors.forename: Egidio
authors.initials: E
authors.lastname: Riggio
authors.forename: Andrea
authors.initials: A
authors.lastname: Spano
authors.forename: Joseph
authors.initials: J
authors.lastname: Ottolenghi
authors.forename: Maurizio B
authors.initials: MB
authors.lastname: Nava
mesh_terms: D000328:Adult; D018427:Breast Implants / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016462:Mammaplasty / Q000379:methods* / Q000523:psychology*; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D017568:Rectus Abdominis / Q000601:surgery; D013524:Surgical Flaps; D011795:Surveys and Questionnaires; D013997:Time Factors