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Mommy Makeover: 4 Things You Should Think About

Posted: September 21, 2016 > Body > Breast > breast augmentation > breast lift & reduction > Featured Post > interesting & new > liposuction > Mommy Makeover / Body post baby > Post Pregnancy Body > Post Pregnancy Breast > tummy tuck > Blog Home

laurengreenberg_mommymakeoverThe Mommy Makeover: Catchy name and a growing trend. Particularly for women who have kids at older ages, multiples, or more kids, pregnancy can wreak havoc on the body. When you spend your whole life keeping in shape, to see the changes after babies can be hard.  I have been a plastic surgeon in private practice for over 15 years. I have had 3 kids and breastfed them all.  I do not think everyone needs surgery after babies.  But for some, it is a good choice for health (yes, health) and cosmetic reasons.  There are some things you can’t fix without surgery, and some things which just can’t be fixed.  The mommy makeover combines some kind of breast surgery – breast augmentation, breast lift, or breast reduction- with some kind of body surgery – liposuction, tummy tuck (abdominoplasty), or mini abdominoplasty.  The benefits of combining surgeries are many: lower cost, a single recovery, and fixing all the issues at once.  For healthy patients, the increase in risk is small.  I post here advice if you consider a Mommy Makeover.

1.  TIMING.  I recommend getting back to your normal before doing any kind of surgery. Right after you have babies, you are not sleeping, you haven’t lost weight, you may be breast feeding.  Your body has been dedicated to growing and feeding another being.

You should enjoy your new baby and give yourself time.  They body bounces back a lot after pregnancy on its own.  Wait until the dust has settled, so you can see what, if anything, needs to be fixed.

  • Typical time frame varies, but for many patients surgery is 2-3 years after their last child
  • Wait until at least 3 months after you stop breast feeding for any breast surgery
  • Ideally you should be done with having kids
  • Surgery is a stress to the body. You need to be rested, strong, and healthy.
  • You need a lot of help around the house for the first 1-2 weeks.

2. WEIGHT.  You should be back to your ideal body weight prior to any surgery if you can do it. I get how hard it is to lose weight.  All those who say their weight “just flew off” while they were breastfeeding or chasing their kids are lucky.  Most women work to reclaim their pre-baby weight.

Being at your ideal weight prior helps us see what your body looks like after babies.  How is your skin tone? Do you droop? Are your abdominal muscles separated?  I see many women who get back to their pre-baby weight only to find their bodies don’t fit into clothing like it did.

Losing weight after some surgeries can be problematic, as it can change the appearance, skin laxity and droopiness, or body proportion.

3. WHAT CAN’T BE FIXED WITHOUT SURGERY?

There are things which won’t get better with sheer will and determination, or with time.  I think it is good to know what these are, so you don’t chase products or quick fixes which won’t work.

  • Small breasts.  Many women who were happy with their breast size before pregnancies are unhappy after.  This can be due to the breasts shrinking after babies (which can occur with breastfeeding or weight loss), or from getting used to and liking having the larger breasts of pregnancy and breastfeeding.  The fix for small breasts is breast augmentation.
  • Droopy breasts.  Try as you might, there is no exercise to lift and tighten skin.  If your breasts sag after babies, a breast lift can help.  If your breasts are too large and sag, then a breast reduction is the answer.
  • Umbilical hernia.  If you are now an “outie” at your belly button when you were an “innie” prior to kids, it is a small hernia in the belly button.  A hernia is an actual tear in the abdominal wall, and a knuckle of your insides (intestine, fat, etc) pooches out. We can fix this when we do an abdominoplasty.  Insurance may cover part of your surgery cost.
  • Hanging abdominal skin.  When the skin stretches to accommodate the baby, it needs to shrink back after the baby.  If it can’t shrink back, it will hang.  The risk factors for skin retraction issues are many: pregnancy weight gain, pregnancy of multiples, older age of the mother, and number of kids.  You can’t tone up skin by lasers or exercise. The best way to understand skin is to think of skin like a bathing suit.  Some bathing suits bounce back when stretched, some don’t.  Some used to bounce back, but after a few summers can no longer do so.  As you age, particularly in perimenopause, your skin elasticity worsens.  The only way to tighten skin is to cut out the extra skin, which is a tummy tuck.
  • Muscle separation.  Your abdominal muscles form your core.  These are made of your rectus muscles (the six pack) and oblique muscles.   When you carry your baby, you do so behind these muscles, and the pregnancy can cause the muscles to separate along the midline.  We call this a diastasis.  Some of this shrinks back after you give birth.  But for many, the separation stays.  This can give you a poochy belly, which makes you look pregnant when you are not.
    • Some separation may be fixed by targeting the muscles with exercise.  If you haven’t tried to focus on your core, do so.  Pilates, sit ups, and the barre courses are good places to start.
    • For many the separation can’t be fixed no matter how many sit ups you do, as the muscles are not touching.  During a tummy tuck I corset these muscles back together.
    • Some doctors will call a severe case of diastasis a “ventral hernia.”  I find a true hernia is rare.
    • Insurance may cover part of your surgery if your diastasis is severe.  These are women who look six months pregnant all the time.

4. WHAT JUST CAN’T BE FIXED?  There are some changes after pregnancy which are not fixable.  I bring these up to save you frustration, as I see many women expend time, energy, and money on these issues with no results.  Sometimes procedures like lasers and peels give temporary improvement, but won’t fix it.  Some of my colleagues may disagree, and I encourage you to meet with a board certified plastic surgeon for an evaluation, but the following are tough issues:

  • Stretch marks.  People have a genetic predisposition to stretch marks.  If your mom had stretch marks, or you have them from growing or weight changes, you are at risk.  When a stretch mark forms and is red, you may have a window to improve the stretch mark with lasers or peels.  This can narrow or lighten the stretch mark.  Once a stretch mark is mature, changing it is difficult.  (If they form in the lower abdomen, this skin is removed with a tummy tuck.)
  • Loose skin in the upper abdomen.  I see this frequently in thin women with a small amount of hanging or wrinkled skin just above the belly button.  The upper abdomen is difficult, because there is nowhere to hide a scar.  You cannot hide a scar in the belly button.  There is no laser or exercise which tightens the skin effectively long term.  These women are not a candidate for a full tummy tuck because they don’t have enough loose skin.  A mini tummy tuck removes skin from the lower abdomen only- it can’t help much of the upper abdomen because the umbilicus serves like an anchor.  This is one where I advise to live with it, and try to improve your posture as much as you can.   Sometimes peels can give temporary improvement, and I do have patients who do a peel at the beginning of summer to help their belly look a little better through bikini season.
  • Intraabdominal fat.  When your waistline thickens with age after pregnancy, some of the fat is external and some is internal.  The external fat can be removed by liposuction or a tummy tuck.  The internal fat is behind the rectus muscles, the “beer belly” on some men.  The only way to shrink this fat is to lose weight.

A Mommy Makeover is a great surgery for many women.  Particularly here in the Bay Area, I see many women who have multiple children at an older age.  As plastic surgery has become more accepted and as women are active and fit longer, there is a general attitude of “if I can fix it, why not?”  I urge you to have a few consultations with Board Certified Plastic Surgeons who perform all of the procedures you may need.  (Many “plastic surgeons” are not board certified, and if they do not do tummy tucks or breast reductions, they may not recommend the right procedure because they are not trained to do it.).  If you are in a grey area of what you need, you may get differing opinions of your options.  It is important to know your options, and the pros and cons of each.

For more information, you can read my extensive blogs and website information at https://www.laurengreenbergmd.com/mommy-makeover/

Please keep in mind: subjects covered in this blog and certain tips and advice are not substitutes for professional medical advice. This blog is for general informational purposes only. If you are considering plastic surgery, reconstructive surgery, or cosmetic enhancement, you should always consult with a board-certified plastic surgeon and/or your general practitioner in-person for professional medical advice.

If you think you may have a medical emergency, call your doctor or (in the United States) 911 immediately. Always seek the advice of your doctor before starting or changing treatment.

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