By Karen M. Horton, MD, MSc, FRCSC
What is the “Mommy Makeover”?
Mothers devote so much of themselves and their resources to their children, from time and energy to money and miles on the car. Moms feel good about this, knowing that every sacrifice is more than worthwhile to keep their family healthy and happy. But sometimes, in all mothers do, their own well-being gets a little forgotten. What if you could take great care of yourself and raise your children too? That’s exactly the philosophy behind “Mommy Makeover” cosmetic surgery. More than ever, exciting surgical options are available to reverse the unwanted effects of childbearing and age.
A Mommy Makeover is a cosmetic surgery procedure(s) aimed at making a mother look the way she did before she had children, or perhaps even better than before! Many of today’s moms don’t feel they should sacrifice the way they look just because they’ve had children. Women usually desire to have their abdominal contour and tone and breasts back the way they were prior to pregnancy. The American Society of Plastic Surgeons (ASPS) reports that demand for those three procedures rose by 11 percent for women ages 20 to 39 between 2005 and 2006.
Aimed at mothers, the Mommy Makeover usually involves a breast lift with or without breast implants, in addition to a tummy tuck if desired and/or liposuction of localized fat deposits that are resistant to a healthy diet and regular exercise. These procedures are intended to eliminate slackened skin as well as reduce stretch marks and pregnancy fat.
Pregnancy affects each woman differently, with age and genetics playing a role in how the body recovers. Some women easily get their pre-pregnancy bodies back when they have completed childbearing. However, most women have permanent changes after pregnancy, such as stretch marks, breast deflation or drooping, extra abdominal skin and/or loss of abdominal muscle tone, known as “rectus diastasis”“(permanent separation of the rectus abdominis muscles). Repeated pregnancies and magnify these changes.
Most of these changes to a mother’s body cannot be fully corrected by diet and exercise, or by lifestyle choices. This article will review the surgical options available for moms to rejuvenate their bodies when they have finished childbearing.
BREAST REJUVENATION
Breast Lift (Mastopexy)
Pregnancy and breastfeeding contribute to deflation and drooping of the breasts. Natural loss of skin elasticity with age, gravity and other factors such as weight loss permanently affects the shape and firmness of the breasts.
A breast lift, or mastopexy, reshapes the breast, removes excess skin, lifts breast tissue and moves the nipples and areolae to a more youthful position. The areola is often reduced in size as well. In some instances, an implant is also inserted at the same time to achieve more projection and volume with the lift. While these are all physical results that occur from breast lift surgery, what breast lifts really do is help a patient feel better about their feminine shape and contour.
Incision lines are permanent, but are generally hidden in the breast crease, at the junction of the areola and breast skin, with a vertical scar beneath the areola. Surgery takes two to three hours on average and may be done as an outpatient procedure (no overnight stay).
Image from the American Society for Aesthetic Plastic Surgery (ASAPS), 2007.
Usually, suction drains are placed to gently remove wound fluid. These small tubes are in place for up to a week after surgery, and are painlessly removed in the office. Dissolving sutures (stitches) are generally used for all types of plastic surgery, with suture knots trimmed in the office at two weeks.
Breast lift side effects can include temporary discomfort, bruising, and swelling. Breasts may be temporarily numb, and healing skin may look and feel dry. Scars fade over the first year, and scar therapy is initiated at a few weeks after surgery to help flatten and fade scars while they are maturing over the first year. Fortunately, scars are in locations easily concealed by clothing, even low-cut necklines and swim suits.
Results of a breast lift are permanent. However, gravity, weight changes and age will continue to act on the breasts, as in all areas of the body and can create the need for eventual revision after many years.
Breast Augmentation
Augmentation of the breast (a “boob job”) consists of insertion of a prosthesis (implant) inside the breast to enlarge the breast or to add volume that has been lost after pregnancy or breastfeeding. The implant expands the breast area to give a fuller breast (increased cup size), give a better contour, and more cleavage that before surgery. A good Plastic Surgeon will emphasize realistic results and help you choose a shape and size that is safe and healthy for your height and frame.
Image from the American Society for Aesthetic Plastic Surgery (ASAPS), 2007.
Implants can be filled with either saline (salt water) or silicone gel, and can be smooth-shelled or textured, round or shaped, with low-, medium-, or high-projection, and come in a variety of sizes. Breast implants are inserted through a variety of incisions, most hidden in natural creases of the body. They may also be placed either in the subglandular position (beneath the breast tissue) or submuscular position (behind the breast tissue and pectoralis major muscle).
Your Plastic Surgeon will explain in detail the many options available for breast implants, and the advantages and disadvantages of each type. Surgery takes one to two hours on average, and is often done as outpatient procedure. If other procedures are done at the same time (tummy tuck, liposuction), an overnight stay is often recommended for safety and comfort.
Breast implants are safe, and are the most extensively tested medical device available. Temporary symptoms after surgery can include discomfort, bruising, soreness, swelling, temporary change in nipple sensation and breast sensitivity. You can still have mammograms with implants in place; the technician will perform special views to ensure all breast tissue is properly evaluated. There has been a significant amount of controversy over the use of silicone in breast implants, with sensationalization of these devices by the media.
Breast Reduction
A breast reduction treats typical symptoms of hypermastia such as back pain, neck or shoulder pain, shoulder grooving, rashes beneath the breasts, and inability to fit clothing or to do physical activities due to the large size of the breasts. The size of the breasts can be reduced by up to half their volume.
The breasts are automatically lifted, and the nipple and areola are lifted to a higher position. The areola diameter is also usually reduced. Liposuction of fat rolls at the side of the breasts or in the armpit area may also be recommended to best improve the breasts’ contour.
Image from the American Society for Aesthetic Plastic Surgery (ASAPS), 2007.
The scars from breast reduction are generally the same as for a breast lift. Based on symptoms arising from large breasts, insurance companies may cover part or all of the costs of surgery. Your Plastic Surgeon will evaluate whether a breast reduction is medically indicated and will contact your insurance company to request pre-authorization for surgery when appropriate.
What to Expect after Breast Surgery
After all types of breast surgery, mild swelling of the breasts and mild discomfort can be expected for a week or two. Physical restrictions include avoiding lifting more than five pounds for two to three weeks. You may resume most normal activities, including mild exercise, after a few weeks. Sexual activity should be avoided for one to two weeks.
TUMMY CONTOURING PROCEDURES
Tummy Tuck (Abdominoplasty)
An abdominoplasty, or “tummy tuck” enhances the body contour by making the abdomen firmer and flatter by removing extra tissue. Lower abdominal skin and fat is permanently removed, creating a scar that lies in the panty line and extends from hip to hip. The belly button is also relocated to a normal position on the abdominal wall, creating a small scar around the navel.
A tummy tuck also tightens the muscles of the abdominal wall that have been weakened or separated by pregnancy by way of “rectus plication” (internal corseting sutures). A tummy tuck can remove some stretch marks, especially those located below the navel.
Image from the American Society for Aesthetic Plastic Surgery (ASAPS), 2007.
Other procedures such as liposuction are sometimes performed together with a tummy tuck to best improve the contour of the abdomen, and to recreate a well-defined waistline in a single procedure.
Mini-Abdominoplasty
Often, if there is only a small amount of excess fat in the lower abdominal region, a “mini-abdominoplasty” is recommended. A mini-tummy tuck subtly raises excess fat and skin below the belly button, creating a more appropriately contoured lower abdomen. The mini-tummy tuck targets the lower part of the tummy, and is especially beneficial to women whose lower abdominal muscles have been weakened by pregnancy.
Scars are shorter, the belly button is not moved, and recovery time can often be shorter. The muscles can also be tightened during a mini-tummy tuck, though not quite as effectively as during a full tuck.
Recovery from Tummy Tuck
Usually an overnight stay is recommended after a tummy tuck if it is combined with other plastic surgery procedures. Tummy tuck side effects include temporary discomfort, swelling, bruising. Excessive bending and high-impact physical activity (including very active sexual activity) should be avoided for up to four to six weeks. Small drainage tubes will be in place for one to two weeks, and are painlessly removed in the office. Often, an abdominal binder (stretchy girdle-like garment) is worn for up to two months to help decrease swelling and encourage skin contraction. Scar therapy, like for breast surgery, is often initiated to decrease the appearance of scars.
BODY CONTOURING
Liposuction is a technique used to decrease local fat deposits in areas such as the hips, inner or outer thighs, abdomen, flanks, back or neck. Excess fat is permanently removed using a special wand called a cannula and a vacuum to create a smoother, more attractive body contour and better self image.
In this technique, tumescent fluid containing normal saline (sterile saltwater), epinephrine/adrenaline (to shrink blood vessels and decrease bruising and bleeding) and lidocaine local anesthetic (to numb the area) is injected through small incisions. The liposuction cannula is then inserted and fat is gradually removed until the contour of the area being treated is improved. Some liposuction machines make use of ultrasound to melt the fat before it is removed; others use a power-assisted handle to decrease surgeon fatigue.
Image from the American Society for Aesthetic Plastic Surgery (ASAPS), 2007.
A compression garment is then applied to gently compress the area and to encourage skin contraction and decrease swelling. Garments are generally worn for up to six weeks. You can return to light activities within a few days and to normal activities within about two weeks. Bruising, swelling and soreness may occur for a least a few weeks. Swelling generally subsides within six weeks, and the final contour is evident by three months.
Good candidates for liposuction include women who are of average weight with firm, elastic skin, and who are in good overall health. Liposuction treats only concentrated pockets of fat that do not respond well to diet and exercise, and is not a weight-loss method. Liposuction should only be done after your ideal body weight has been most closely achieved through diet and exercise.
WHAT TO LOOK FOR IN A PLASTIC SURGEON
Any cosmetic surgery is a major procedure. It is important that all women seeking a Mommy Makeover understand that risks attend even minor procedures. There is no guarantee that the effects will be exactly as you might envision. The best assurance you have for a reliable outcome is to choose an experienced Plastic Surgeon who is Board Certified and has experience and expertise with the procedure(s) you are interested in.
Your surgeon’s specific training and judgment will help to determine which procedures best meet your goals, while minimizing complications and ensuring the best possible outcome. There should be a good “fit” in personality between you and your surgeon, with effective communication, and a trusting relationship between the two of you. Visit a number of Plastic Surgeons for a consultation until you feel you have found the very best fit for you!
A Word of Caution
There have been an overwhelming number of television shows highlighting some of the procedures offered by “cosmetic surgeons”. Not all of these surgeons are Board-Certified, and some are not formally trained in Plastic Surgery. It is important to do your research prior to committing to any surgery.
Your Plastic Surgeon should be Board-Certified in Plastic Surgery by the American Board of Surgery or the Royal College of Physicians and Surgeons of Canada. Checking professional association websites such as the American Society of Plastic Surgeons is often a good resource for background information.
SUMMARY
With all these options available, and increasing awareness of plastic surgical procedures, why don’t all women seek a Mommy Makeover? Some women are worried about focusing on themselves, rather than their families. However, many women realize the importance of focusing on both family and themselves!
Moms should wait at least six months after completing their last pregnancy and breastfeeding before considering any surgical procedure. Women should be in good physical shape – a healthy diet and regular exercise regime should be optimized for at least six months before surgery. Smoking should be absolutely eliminated for at least six weeks before elective surgery, and alcohol should be in moderation.
How you feel about yourself as a mother and a woman is integral to the strength of your family. It is not self-centered or vain to take care of yourself or to want to feel youthful, sexy and self-confident. Having a positive self-image certainly benefits you, but it also can improve your interactions with loved ones. You may be a Mommy, but never forget that you are still your own person.
ABOUT THE AUTHOR
Dr. Karen Horton is one member of a unique all-woman Plastic Surgery practice, “Women’s Plastic Surgery” in San Francisco.
Dr. Horton is a Board-Certified Plastic Surgery and Reconstructive Microsurgeon. Her special training and interests include reconstruction of the breast following breast cancer, reconstructive microsurgery and cosmetic surgery of the breast and body, including the “Mommy Makeover”.
She has published review book chapters on breast reconstruction and presented numerous clinical papers at national and international scientific meetings. In addition to participating as an active member of many professional associations, she serves as a mentor to young female surgeons and medical students in training. To contact Dr. Karen Horton or learn more about the doctor, please visit her Make Me Heal Profile.Â
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