"Mommy makeovers" help in the return to: "Before Baby"
Many young and middle aged moms are disgruntled with the anatomic changes that can follow pregnancy. The first task, of course, is for each mom to work off as many of those extra pounds as possible employing sensible diet and exercise. However, these measures can only go so far to restore form when the skin and supportive structures of the body have been permanently altered.
Pregnancy and lactation related changes to breast volume and shape are quite unpredictable, and may produce any or several of the following:
- persistent loss of volume (smaller breasts)
- loss of projection
- loss of youthful upper breast fullness
- descent of nipple to unattractive location
- increased pendulousness
The most common surgical solutions involve breast volume enhancement with implants, breast lift ("mastopexy"), or some combination of the two. A careful analysis by the surgeon and frank discussion about a patient's goals must guide the treatment planning process. (This patient underwent augmentation and mastopexy combined.)
... and the Abdomen
Post-partum changes to the tightness and contour of the abdomen are also issues that the plastic surgeon may effectively address for well selected individuals. Anatomic analysis will reveal to what extent the skin, subcutaneous fat and abdominal wall contribute to the overall contour problem, and will direct the choice of surgical technique. Not surprisingly, patients will often present with concerns about both the abdomen and breasts. For carefully selected individuals, combination surgery for the breasts and abdomen can yield gratifying changes.
This healthy, 40 year old mom of three had decided that she would have no more children.
Her concern regarding her breasts was for what she described as a loss of "perkiness." She was satisfied with the post-lactational volume of her breasts.
She also complained about a persistently thick and "flabby" lower tummy that would not respond to her best efforts with reasonable diet and exercise. She was fairly close to her pre-third pregnancy weight, but felt, (quite realistically), that returning to the weight she maintained before having any children was not likely possible.
The patient underwent a one-step combined procedure that included breast lift, ("mastopexy") and high lateral tension abdominoplasty.
The images presented here show successful re-orientation of the nipple/areolar complexes and diminution in pendulousness of the breasts. The abdominal skin and musculature have been tightened and the heaviness of the lower abdomen addressed. This combined procedure was accomplished in five hours.
This mother of two had completed her childbearing and sought a rejuvenation of both her breasts and abdomen.
Breast feeding had left her with diminished projection and an overall breast volume that was somewhat less then she had enjoyed prior to her pregnancies. She wanted improved breast projection and a return of youthful fullness to the upper breasts.
She was unable to eliminate the extra thickness in her central abdomen and was disturbed by the fact that her lower belly appeared to "over-hang" her C-section scar.
The breasts were treated with modest augmentation together with vertical mastopexy.
Since the abdominal skin quality was reasonable and the abdominal wall in little need of repair, treatment of the abdomen could be limited. Liposuction of the entire anterior abdomen was accomplished, followed by a "mini-tuck" type skin tightening accomplished through the old C-section incision. The original incision was made a bit longer in order to allow proper tightening of the loose, infra-umbilical skin. This procedure was completed in four and one half hours.
This young mother had not had a substantial weight problem until her pregnancies. After each of three births she retained some of her pregnancy weight. Following our prescribed weight loss plan the patient re-presented with the appearance seen at the far left. Her BMI had gone from 34 to 30.
She complained that her breasts were too large and pendulous and that her abdomen was loose and still protruding.
This patient underwent moderate bilateral breast reduction together with limited undermining abdominoplasty and liposuction.
She was pleased with the outcome of a procedure that took five and one half hours to perform. Patients of this type are at greater risk for complications and need to be carefully and fully advised regarding potential problems. Of particular concern is the risk for thrombo-embolic phenomena (venous blood clots), which can be dangerous. Limiting abdominal dissection in this operation was one of many measures employed in order to help limit risk.
A 42 year old mother of five presented with multiple complaints. She was distressed by loss of breast shape and volume that followed her breast feeding.
She felt that her breasts had a "deflated" look and also welcomed the opportunity to seek a volume improvement that she had considered from her youth.
Greater than her distress over her breasts, however, was her concern about her abdomen. This thin woman had suffered substantial damage to her abdominal wall and the overlying skin, leaving her with marked abdominal protuberance and broad areas of thin, loose stretch-marked skin.
Consultation discussions yielded a plan for breast augmentation and abdominoplasty. For a variety of reasons, the patient elected to undergo this process in a staged manner rather than having one, longer operation.
Since the abdomen was her greater concern it was decided that abdominoplasty would be done first, followed some months later by the breast surgery. This can be a prudent approach for patients willing to accept a second operation and helps limit operative time and risks for each procedure.
Left is a pre-op anterior view before any surgery. Right shows post-op view after completion of both procedures.
Similar pre- and post-op images from an oblique view.
It is important to be careful in the use of glib terms such as "makeover." It should never be implied that the plastic surgeon can fully reverse the changes that nature brings about through pregnancy and childbirth. In well selected cases, the surgeon can do much to restore form toward its pre-pregnancy appearance, but there are real limitations in this type of surgery and great differences in the types of outcomes different individuals can expect.
It is also well to note that combined procedures, though often appropriate, must be considered very carefully. The cautious surgeon will seek to limit operative times and will discourage enthusiastic patients who may seek the simultaneous performance of too many procedures.