Endoscopic placement of breast implants has been described through an umbilical incision. Limitations include the fact that only inflatable implant can be used through umbilical approach. The purpose of this study is to describe the authors' evolutionary transumbilical technique with cohesive silicone gel implant insertion and to retrospectively analyze preliminary results. The authors' technique is the placement of a cohesive silicone gel implant using a transumbilical approach in a subpectoral plane. Patients who were selected had mammary hypoplasia without ptosis and who requests breast augmentation with a scarless and natural feel breast were considered candidates. The technique and indications are presented thoroughly. From June of 2011 to January of 2012, 42 women aged 23 to 46 years (average, 31.6 years) underwent the endoscopic transumbilical breast augmentation. All patients had round silicone implants placed in the retropectoral pocket location. The results of this study indicate that transumbilical technique is highly successful. Complication included transient periumbilical bulging (5 patients, 11.9%), hypertrophic scar needing revision (1 patient, 2.3%), and conversion to other breast incision due to capsular contracture (3 of 84 breasts, 3.5%). Transumbilical breast augmentation with prefilled implant is a safe and attractive technique for breast implant placement in selected patients. With this inventory modification, the result can permit surgeons expanded spectrum of implant selection for transumbilical approach.