Mommy Makeover

Pregnancy can take a toll on our bodies, affecting our breasts, tummies, legs and more. After nine months—or more, if nursing—you are probably longing for your pre-baby body. Whether you choose a healthy regimen of diet and exercise, minimally invasive cosmetic treatments, cosmetic procedures or all the above, you might also consider a Mommy Makeover to get back in shape.

Many plastic surgeons are now offering what they call the Mommy Makeover, which addresses a woman’s post-pregnancy body issues in a single-session surgery (may be staged into more than one operative session) that typically combines the following:

• Tummy Tuck
• Breast Enhancement – Lift or Augmentation 
• Fat Removal with Liposuction

From a cosmetic standpoint, Mommy Makeovers address pregnancy-related changes in both the breasts and the tummy. While this is a great way to take care of two of the biggest post-pregnancy complaints in one operation, it’s important to remember that combining procedures leads to longer surgery time and potentially a greater risk of complications. The biggest concern with multiple procedures in one surgical session is the length of time the patient is under anesthesia, but a tummy tuck and breast surgery are frequently performed at the same time, and usually take from three to six hours, which is reasonable according to many surgeons.

Other treatments often combined with the Mommy Makeover include:

• Skin tighteners
• Cellulite treatments
• Stretch mark improvement

With all the stress we put on our midsections—during pregnancy or with weight gain and loss—it’s no wonder that, as we age, the shape and size of our stomachs change. When diet and exercise don’t provide the results that you want, a surgical procedure like a tummy tuck (or lipoabdominoplasty) may be your best option, assuming you and your doctor agree you are a good candidate for this procedure.

The only way to fix the problem is with a tummy tuck, but tummy tuck surgery is one surgery that’s not considered a walk in the park.

A tummy tuck permanently restores firmness to the stomach and removes any loose skin. During the procedure, an incision is made at the pubic bone (your scar, once healed, will be concealed by bathing suits and underwear) through which your plastic surgeon will tighten up the muscles. Small pockets of fat can be removed with liposuction. Once the muscles are tightened—some doctors like to make the muscles as tight as possible so that the stomach will keep its new shape as long as possible—and the excess skin is removed.

Depending on the extent of your particular post-pregnancy concerns, there are a variety of tummy tuck procedures that treat different degrees of muscle and skin laxity. Some procedures are performed with limited incisions and leave shorter scars.

Here are the various types of tummy tuck surgery you will may want to consider either as part of your Mommy Makeover or as a single procedure:

• Traditional Tummy Tuck – full abdominoplasty
• Extended Tummy Tuck – belt lipectomy
• Mini Tummy Tuck – short scar or small incision abdominoplasty
• Reverse Tummy Tuck – the incision is made from the breast bone to the stomach
• Nonsurgical Body Contouring – using liposuction, lasers or injectables

Women who have had C-sections (or Cesarean sections) are in luck—your plastic surgeon can either use or remove that incision while performing the tummy tuck, so you will have only one scar. 

The joys of motherhood are boundless but the effects of pregnancy on your body can sometimes be drastic. During pregnancy, your body can change in ways you never expected. Some women are lucky, and bounce right back to their pre-pregnancy bodies; others struggle to get close to what they looked like before having children.

A typical post-pregnancy breast problem

Your breasts were a perfect size and shape before and during pregnancy, but after breast-feeding they are a sagging or have lost tissue.

This happens because during pregnancy and even into breast-feeding, the breasts are greatly affected by hormonal changes. “Once these hormones decrease, the tissue deflates,” says Orlando, FL, plastic surgeon Armando Soto, MD.

Breast enhancement—such as augmenting with implants or a breast lift—can restore shape and size to your breasts, even making them bigger and fuller than they were before you got pregnant. “When upper pole fullness is lost, it needs to be restored with implants,” says Orange County, CA, plastic surgeon Al Aly, MD.

Mt. Pleasant, SC, plastic surgeon Thomas Hahm, MD, adds, “In general breast augmentation creates a larger size with small changes in the nipple height.” With two different implants to choose from—saline and silicone—and a few different placement and incision options, too, your plastic surgeon can fill your breasts out just a little or take you substantially larger. “For those who want to look most natural, silicone implants are usually the better options,” says Dr. Armando Soto.

It’s important to know that post-pregnancy breast augmentation patients may not be candidates for implant placement through the armpit if their breasts are droopy. “It may be more appropriate to place the implant through an incision around the nipple or in the breast crease so the surgeon can manipulate and adjust the tissues,” says Dallas, TX, plastic surgeon Jeffrey Kenkel, MD. Incision placement is a key area of concern, so always consult with your surgeon in your pre-op evaluation.

Types of Breast Enhancements

Breast lift: If you want a long-lasting solution to sagging breasts or loss of breast volume, you may want to consider a breast lift. But just lifting the breast won’t solve the problem in everyone.

“If there is a loss of volume and sagging skin, then you probably need a lift and implant to recapture the shape,” says New York, NY, plastic surgeon Elie Levine, MD. “A breast lift leaves behind more scarring than an augmentation does. For those who are opposed to the idea of having large scars on their breasts, and are good candidates, going with implants that may be a bit larger will give some lift and produce far smaller scars,” says New York plastic surgeon Alan Matarasso, MD.

If you’re satisfied with the size of your breasts but you just want them to sit a little higher, then a breast lift may be the surgical solution for you. Breasts sag after pregnancy because of stretched-out skin and underlying supporting tissue. Breast appearance can be improved by removing excess skin.

To restore pre-pregnancy perkiness, a breast lift reduces the excess skin and remodels the breast tissue so it can assume a higher position. There are a variety of breast incision placement options, and some women can benefit from newer, more limited incision techniques that allow for smaller and perhaps fewer incisions for less scarring. Regardless of the approach your surgeon deems best for you, it’s important to know that all breast lift surgery results in scars that typically go from the nipple down to the breast crease, and possibly along the breast crease as well.        

Breast implants: Dr. Jeffrey Kenkel says, “Most post-pregnancy patients just want to be the same breast size they were before or just a little bigger, and in the right woman, implants alone can restore fullness and add projection.” If you’re happy with the position of your breasts but you’d like them to be a little fuller, implants can help replace the breast tissue that diminishes after having a baby, and may even be able to eliminate the need for a breast lift as long as you have healthy, elastic skin and no excessive drooping. In addition to enhancing breast size, implants can also help restore pre-pregnancy firmness. 

Liposuction alone can remove fat, but it cannot do anything to treat stretched muscles or extra skin. Landsdowne, VA, plastic surgeon Phillip Chang, MD, says, “A tummy tuck takes care of all of the abdominal issues experienced by post-pregnancy women—the stretch marks, excess skin and stretched abdominal wall—and also gives surgeons the ability to bring in the waist like a corset.” That’s why liposuction is often performed in conjunction with the Tummy Tuck to accentuate the waist and add definition to the abdomen. This is a crucial part of any Mommy Makeover. A nicely contoured waist blends into the flattened abdomen in a natural way. Likewise, a narrowed waist complements the proportions created by the breast procedure. The result is a body that looks much like what the patient had prior to her pregnancy or pregnancies.

All liposuction is essentially suction-assisted lipectomy (SAL)—the removal of fat from the body through the assistance of some form of suction. Fat removal involves the use of a cannula (a thin hollow tube that is inserted below the skin) to manually loosen fat. Suction is applied through the cannula to remove the fat from the body with specialized vacuum-powered equipment. For small, localized areas such as the face, or to harvest fat for transfer, suction may be manual, using a large syringe attached to the cannula.

Improvements in SAL include the ability to use smaller cannulas, thereby leading to smaller incisions and more precisely sculpted contours. This is made possible by accompanying SAL with specialized techniques, mainly tumescence and ultrasound assistance.

Skin Tighteners: For the lucky few who just need a minor bit of tweaking, a skin-tightening treatment can help. “To nonsurgically treat loose skin we can use a combination of methods like a prescription-strength retinol cream, to produce collagen, followed by lasers that help build collagen,” says Dr. Jody Levine. Even if your skin responds to treatment, you’ll never get the same result with a skin tightener (brand names to look for are Thermage, Exilis and Accent Your Body), as you will with surgery because the extra, loose skin still exists to some degree. On average, the results are not permanent—maintenance sessions need to be done about once a year—and results are not predictable since not everybody responds to these types of treatment.

Cellulite treatments: Some anti-cellulite treatments like VelaShape and VelaSmooth may help to minimize cellulite. Before embarking on surgery or even noninvasive treatments to treat cellulite, you may want to look into diet and exercise programs to get your body back on track.

Why do stretch marks appear?

Weight gain and loss due to pregnancy or other reasons forces skin to stretch more quickly than it would normally. There is a “pulling” on the dermis that causes the collagen to weaken and break down.

While there’s no miracle cream that can fully prevent stretch marks from forming (they are genetic to some degree), you may be able to minimize the chances of getting them, or reduce their severity, by keeping the body well moisturized.

Stretch marks can appear almost anywhere on the body but they usually develop on the stomach, breasts, thighs, hips and butt during pregnancy.

How to treat stretch marks

If your stretch marks aren’t fading, there are laser skin-resurfacing treatments that will help reduce them. Consult with a cosmetic plastic surgeon about how to best reduce or eliminate them. 

Results from laser skin treatments for stretch marks are not considered permanent.  “Using a laser like BBL, SkinTyte and/or a pro-fractional laser can reduce the appearance of the redness, minimally tighten the skin and improve the texture,” says New York dermatologist Jody A. Levine, MD. 

Stretch marks can also be excised during a tummy tuck if they’re below the belly button they’re cut out. If they’re above the belly button they are repositioned further down on the stomach. 

Women wanting to restore their body closer to their pre-pregnancy appearance

Most plastic surgeons recommend letting the body heal for at least six months after delivery before surgery. You’ll also need to have stopped breast-feeding so your doctor can get an idea of the true size and position of your breasts. If you are done having children, it is safe to go ahead with a Mommy Makeover.

If you are planning on having additional children, you may want to wait to have your Mommy Makeover until you are done with all of your pregnancies. Pregnancy following tummy tuck surgery is possible and is not dangerous, but if you plan on future pregnancies, you should wait to have a full tummy tuck with muscle repair until you are done having children, since pregnancy will stretch out the skin and abdominal muscles again, usually undoing the repairs that were achieved with the abdominoplasty

Because recovery involves post-treatment care for multiple procedures, it might affect caring for children during recovery. It is important to discuss post-surgical care with your surgeon to fully understand what is involved after surgery, how long recovery time will be and when you can expect to see results.

How do I know if I need liposuction or a tummy tuck?

If you’re not sure if you’ll need liposuction or a tummy tuck, your plastic surgeon can give a professional opinion as to which procedure, or combination thereof, can best rectify the situation at hand. But you can do a little “test” at home, too. Lie on the floor, flat with your head down. Any bulging in the belly indicates the muscles have separated and need to be remedied with a tummy tuck. Liposuction will vacuum away excess fat and leave behind a thinner abdomen with firmer skin; a tummy tuck will tighten and flatten the stomach, and also get rid of any skin that’s loose and flabby.