The following is an overview of the T.U.B.A. Procedure:

	1.) Prior to surgery, the patient is marked for the implant pocket dissection area and for the path the endoscope will follow during the procedure. The incision is made inside the belly-button as shown by the small inset in the illustration to the left.
	2.) Once the incision has been made, some initial undermining is done to allow for insertion of the endotude.
	3.) The endotube is advanced to a point beneath each breast which creates a tunnel from the belly-button to the point the pockets will be created at each breast.
	4.) This sectional view shows the endotube position relative to the breast and the muscle. Dr. Johnson recommends that the implants be placed above the muscle, but Dr. Johnson also performs sub-muscular placement of the implants via the T.U.B.A. procedure.
	5.) The endoscope is used to inspect the tunnels created and assure that the pocket for the implants will be dissected above the muscle.
	6.) The tissue expander is rolled up such that it can be passed through the tunnel from the belly-button to the point where the pocket is to be created beneath the breast tissue.
	7.) By use of the endotube, the tissue expander is put into position beneath the breast tissue.
	8.) The tissue expander is inflated to about 1.5 times the desired volume for the implant by use of a fluid pump, thereby causing the separation of the breast tissue from the underlying muscle and creating the pocket into which the implant will be placed. The tissue expander is then deflated and removed.
	9.) The implant is then rolled up so that it can be passed through the tunnel from the belly-button to the pocket beneath the breast tissue.
	10.) The implant is placed in the end of the endotube, which will be used to push the implant up the tunnel and into the pocket at the breast.
	11.) The implant is placed into position in the pocket beneath the breast tissue.
	12.) The implant is then filled to the proper volume with a saline (saltwater) solution, using a syringe to assure accuracy.
	13.) The implant fill tube is then removed and the implant is left permanently in place.
	14.) Finally after the implants for both breasts have been filled and the fill tubes removed, the incision in the belly-button is sutured closed using disolvable sutures. The patient is wrapped in a pressure bandage and is allowed to go home.
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