title: Transumbilical breast implant replacement.
abstract: BACKGROUND
  The transumbilical approach to breast augmentation has been described in the plastic surgery literature. However, the replacement of failed implants by way of the transumbilical approach has not been fully described.
  
  
  OBJECTIVE
  This article reports the instruments and surgical procedures used in breast implant replacement by way of the transumbilical approach.
  
  
  METHODS
  The initial operative steps for transumbilical breast implant replacement are identical to those previously described for transumbilical breast augmentation. However, instead of advancing the Johnson obdurator deep to the breast on the muscle or chest wall, as in the original procedure, it was elevated away from the chest wall with pressure sufficient to maintain contact with the capsule. A cutting cautery was used to open the capsule. The implant was punctured and nearly evacuated, and the position and orientation of the most accessible fold were assessed endoscopically. An endo-grasper was used to grasp the implant, which was then withdrawn. The interior of the pocket was examined and endoscopic capsulotomy was performed, if necessary, before insertion of the new implant.
  
  
  RESULTS
  Transumbilical breast implant replacement, including size decrease and modest size increase, has been performed on 28 breasts with no complications.
  
  
  CONCLUSIONS
  Although primary transumbilical breast augmentation should be performed only by surgeons who have taken a formal training course, those surgeons who are already familiar with primary transumbilical augmentation can safely perform implant replacement by way of the navel without additional training.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Richard V
authors.initials: RV
authors.lastname: Dowden