Mommy Makeover

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Congratulations on having a baby. It is truly a blessing, and one of the best journeys I have ever taken. As you have undoubtedly discovered, having babies takes a toll on your body, particularly your abdomen, breasts, and skin. Helping women regain their pre-pregnancy bodies is an area of particular interest for me. Most of my patients are women in their late 30s and early 40s, and much of what I fix is what babies ( as well as time, gravity, and life) have caused. I feel strongly our bodies change more than those of our mothers did. Particularly here in the Bay Area, we have babies at an older age, we gain more weight, and we breastfeed. What makes us proud in our playgroups is a healthy child. Our own bodies take second place.

Post-pregnancy surgery should not be done until you have allowed time for your body to fully recover. It is amazing to see what time, exercise, and those healthy habits can do to improve things. But there are typical changes I see among new moms, many of which cannot be fixed by exercise, creams, or sheer will. Patients are often well educated. My goal as your plastic surgeon is to help you evaluate your choices and determine your best option together.

Plastic surgery after pregnancy is not needed by every woman. But for many, it allows us a way to reclaim our bodies after having babies. The benefits to self-esteem and sexuality can be great.

The two major areas affected are the breasts and body.

“I had a breast augmentation and liposuction about 2 months ago and I couldn’t be happier! My body looks 100% natural.” – K.K., Stanford
*Individual results may vary

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Ideal BodyWeight

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 to surgery 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, and body proportion.

TimingFor Surgery

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.

Timeframes vary, but for many, surgery is 2-3 years after their last child
Wait 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.

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.

WHAT CAN’T BE FIXEDWITHOUT 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 having larger breasts with pregnancy and breastfeeding. The fix 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 a tear in the abdominal wall, and a knuckle of intestine, fat, etc. pooches out. We can fix this with a tummy tuck. 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. 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 skin with lasers or exercise. 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. When you carry your baby, you do so behind these muscles, and 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.

I was at the gym when Dr Greenberg’s name came up. My trainer had two other clients that had received her services and were very happy with the results. At 46 years old, three pregnancies and breastfeeding, my body had taken a beating. I have been working out diligently for the last 6 years but recently had noticed that no matter how hard I worked I could not see the results I used to. I had been thinking of breast reduction and tummy tuck. Dr Greenberg’s consultation was very informative. What I liked is that she had pictures with full explanations of what the two procedures would entail. She is also a mom and understood where I was coming from. Long story short I went ahead and had the two procedures. I am so happy that I did them. My breasts look awesome. No more back pain which I didn’t even know was being caused by my breasts. The extra skin on the tummy gone!! I now have a beautifully shaped new belly-button and flat stomach thanks to Dr. Greenberg. I am feeling like myself again pre kids. Thanks Dr Greenberg!

Anonymous

August 20, 2011

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Determining the best course for you requires a careful evaluation of your goals and the realities of what can be done, which I go over in great detail during your consult in my office. The surgery is done in one of two local outpatient, fully-accredited surgery centers. I do frequently combine surgeries. We have busy lives. Many of us work. We all have children. There are benefits to combining surgeries: you are under anesthesia once, you recover once, and some cost savings. You will need someone else to help you with your children immediately after surgery. I jokingly say this is the only way some of us get any “mommy vacation time.” The more you take it easy immediately after surgery, the faster you will get better. As this is elective surgery, this should only be done safely. With some larger surgeries an overnight stay is recommended, and for some a two-stage procedure may be necessary.

For more information, you can read my extensive blogs and my website dedicated to bodies after babies www.bodypostbaby.com.