The Transumbilical Breast Augmentation: Safety and Satisfaction in a Systematic Review and Meta-analysis of 13,210 Breasts

Background As one of the most commonly performed aesthetic procedures, breast augmentation can be performed through several surgical access routes. Transumbilical breast augmentation (TUBA) offers the advantage of implant placement through a concealed umbilical incision. However, despite its aesthetic appeal, evidence supporting its safety, reproducibility, and clinical outcomes remains limited and heterogeneous. Materials and Methods A systematic literature search was conducted in MEDLINE, Embase, Scopus, Cochrane Library, and Web of Science through August 2025. Studies including adult women undergoing TUBA with silicone or saline implants were eligible. Primary endpoints were patient-reported satisfaction and hematoma incidence. Secondary endpoints included capsular contracture, reintervention, infection, seroma, intraoperative bleeding, implant malposition, inadvertent plane placement, implant rupture or deflation, operative time, and other adverse events. Results Seventeen studies were included, encompassing 6,605 patients (13,210 breasts), of whom 6,510 underwent TUBA. Patient-reported satisfaction was consistently favorable across studies, with high satisfaction rates. Single-arm meta-analyses demonstrated low pooled incidences of hematoma (0.2%, 95% CI: 0.1–0.5%), capsular contracture (1.7%, 95% CI: 0.9–3.2%), reintervention (2.3%, 95% CI: 1.2–4.4%), infection (0.0%, 95% CI: 0.0–0.7%), and intraoperative bleeding (0.2%, 95% CI: 0.1–0.8%). Other adverse events were infrequent, and operative time clustered around a median of 60 minutes. Overall, risk of bias was predominantly moderate. Conclusion This study suggested that TUBA resulted in high patient-reported satisfaction and low reported rates of major complications. However, these findings are descriptive and should be interpreted cautiously, because the predominance of retrospective single-arm studies substantially limits causal inference. Moderate risk of bias and short follow-up further preclude definitive conclusions regarding its safety, reproducibility, or equivalence to established approaches. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266 .