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Cosmetic surgery has always focused on the female breast. Second only to liposuction, cosmetic breast surgery is frequently performed around the world. Although the size and shape of the perfect breast changes with time, the concept of perfection does not. Changing the size and shape of the female breast has always been a mainstay of any Cosmetic Surgery practice. Although there are different types of implants and the methods and techniques to perform this surgery are varied, they all have one thing in common: significant scarring of the breast. While most scars heal very well, they are nonetheless, a scar and are therefore permanent. This is both a constant reminder to the patient that she has somewhat altered her body but may also alert others that she has had breast implants. While “scarless” surgery is common in other parts of the body such as the face, it is only recently been introduced to cosmetic breast surgery.
Until recently, breast augmentation surgery produced scars that were either under the breast or around the nipple. With saline implants, we now have two other options. One is to place the incision in the armpit, and the other is to place the incision within the umbilicus or bellybutton.
The TUBA, or Trans Umbilical Breast Augmentation, utilizes an endoscope scope, which is a tiny video camera inserted through a small incision hidden within the belly button. Instruments are used to create a tunnel from the bellybutton to the breast. Through this tunnel, a saline implant is passed. Originally, the implant was only able to be placed above the muscle, but with newer techniques the implant may be positioned under the muscle.
While this surgery is new and exciting, it has not been embraced by all Cosmetic Surgeons. It was a certain learning curve that surgeons must go through to perform this surgery adequately. Patients who have had previous abdominal surgery or who are very thin, may not be a candidate for the TUBA procedure.
As a result, patients now have another option for almost “scarless” breast enhancement surgery. This is termed the trans axillary approach, which places a small one-inch incision in a natural fold located in the patient’s armpit. With this method, a saline implant is easily placed under the chest wall muscle. This position is important for women who have very small breasts and have very little overlying skin. With this approach, the implants look and feel very natural, and there are no telltale scars in or around the breast. The axillary incision also heals very nicely because of the normal armpit hair.
So now with the option of using a bellybutton or arm pit approach, the patient is able to have breast implants that are in essence “scarless” and leave no telltale sign that the patient has had any surgery at all.
While many women desire to have their breasts increased in size, there are other women who are bothered by large, heavy, and cumbersome breasts. Patients are frequently showed the photographs of the wonderful results of a well done breast reduction surgery, only to be concerned about the amount of visible scarring. Along with the scars, comes the risk of loss of nipple sensation, infection, prolonged healing, and the inability to breast feed. Wouldn’t it be wonderful if breasts could be reduced, one to three cup sizes, with only a 1/4″ scar in the crease under the breast?
Today, “scarless” breast reduction surgery can be performed as a special variation of liposuction. The female breast is composed of both fatty tissue and gland tissue. The amount of each depends upon the patient’s genetics, age, and body weight. For the most part, approximately 50% of the breast can be fatty tissue. Liposuction can selectively remove the fat and leave the gland tissue behind. By working close to the skin, a large amount of shrinkage occurs, causing a significant amount of elevation to the entire breast. Women undergoing the surgery are typically back to work and exercise activities in a few days, as compared to a few weeks, with the traditional breast reduction surgery.
So now, the active female, who was bothered by large breasts, can have a significant breast reduction that is almost “scarless” and resume her day-to-day activities with minimal, if any downtime.
Richard A. Joseph, MD
Midwest Surgical Arts
1250 North Mill St. Ste 103
Naperville, IL 60563
(630) 717-8200 | MyCosmeticSurgeon.com
Dr. Richard A. Joseph selected this article for publication based on its clear, patient‑centered explanation of modern “scarless” breast enhancement and reduction techniques. The article outlines how transumbilical and transaxillary approaches, as well as liposuction‑based breast reduction, minimize visible scarring while maintaining natural breast shape and feel. It offers practical insights into incision placement, implant positioning, and tissue‑preserving reduction methods, highlighting their aesthetic benefits and surgical considerations. By emphasizing patient goals, anatomical differences, and the evolving options for discreet breast surgery, the article supports informed decision‑making and personalized care in contemporary cosmetic practice.