What exactly is a “Mommy Makeover”?

The term “Mommy Makeover” is a catch-all phrase often used to describe a wide range of procedures designed to correct the undesirable physical changes that are sometimes associated with pregnancy.   Most commonly, these procedures are directed at the two areas of the body that are the most negatively impacted by pregnancy: the breasts and the abdomen.

While some of these physical changes are reversible with a return to pre-pregnancy body weight, many are not.  It is important for women (and their spouses or significant others) to realize that some of these problems are mechanical in nature, and will not improve even with proper diet and exercise.  Women should never feel guilty that they “just aren’t working hard enough” to return to their pre-pregnancy forms when more than diet and exercise alone may actually be necessary.

Physical Changes associated with Pregnancy

Breast enlargement during pregnancy begins to become noticeable in the first trimester (typically at 6 to 8 weeks), with continued growth occurring throughout the second and third trimesters.  As the glandular elements of the breast enlarge (in preparation for breastfeeding) the overlying skin envelope of the breast and the underlying retaining (Cooper’s) ligaments can become stretched out.  If these structures become stretched beyond their elastic limits, stretch marks and sagging (ptosis) may ensue.  

Similarly, as the uterus and fetus enlarge, so does the entire abdomen.  This can result in 1) overstretching of the skin, 2) the deposition of hormonal (diet-resistant) subcutaneous fat, and 3) separation of the paired rectus muscles.  Again, if elastic limits are exceeded, stretch marks and laxity will ensue.  Furthermore, the separation of the rectus muscles (which is equivalent to a full length abdominal hernia) can produce a generalized abdominal bulge that will never be corrected by any form of dieting or exercise. 

Different women will respond in different ways to these changes.  Women with high elastin contents in their skin and connective tissues (by luck of the genetic draw) will see the tissues rebound and return to their original states without even a single stretch mark remaining.  Others less fortunate will have their tissues stretched beyond their elastic limits.  The result will be small tears in the skin itself (“stretch marks”) and permanent laxity of the skin and supporting ligaments (ptosis).  Again, these are mechanical problems for which a mechanical solution (surgery) may ultimately be necessary.

Breast Procedures

Women with smaller breasts prior to pregnancy will oftentimes like the added volume that the physiological breast enlargement associated with pregnancy gives them.  For this group of women, a simple BREAST AUGMENTATION (with saline or silicone implants) will be all that is needed to re-establish the look that they temporarily had while being pregnant.

Conversely, women with moderate sized breasts may often experience greater degrees of breast enlargement that may exceed the elastic limits of the breast tissues, resulting in eventual sagging of the breasts.  This group of women may want to consider a breast lift, or VERTICAL MASTOPEXY (see Figure 1a), with or without a corresponding implant, depending upon loss or gain of breast tissue volume.

Finally, women with larger breasts to begin with can often experience even further enlargement of the breasts during pregnancy that leaves them with larger and more ptotic breasts than they had to begin with.  In this group, a VERTICAL BREAST REDUCTION would be the ideal choice for establishing a more comfortable breast size and shape.

Abdominal Procedures

Again, women with high elastin contents in their skin and connective tissues can often rebound back to their pre-pregnancy forms with simply an excess of lower abdominal fat remaining.  In this instance, Liposuction alone may be all that is needed to remove the diet-resistant fat that is not going away, even with adequate diet and exercise.

Women who experience accumulation of lower abdominal fat along with some lower abdominal skin laxity may be good candidates for a MINI ABDOMINOPLASTY.  In this instance, the excess skin and the excess fat can be directly excised to re-establish a more pleasing abdominal contour.  

Finally, women who experience a generalized stretching of the abdominal skin, significant accumulation of hormonal fat, and separation (diastasis) of the paired rectus muscles more than likely will require a FULL ABDOMINOPLASTY (see Figure 1b) to fully restore the aesthetics of the abdomen.  Excess skin and fat will be directly removed, and the separated rectus muscles will be tightened back together in the midline.  The end result will be a tightening and flattening of the abdomen as a whole.

Timing of Surgical Procedures

How long does a woman have to wait after having a baby before scheduling the surgical procedures above?  

In general, the body must be given adequate time to rebound back to as close to ‘normal’ as possible.  As much of the added “baby weight” that has been gained during pregnancy should be lost by way of a sound plan of diet and exercise.  In addition, hormonal levels should be allowed to re-equilibrate and stabilize over time.  A reasonable rule of thumb for most women would be to allow for at least six months for the body to reach a new state of physiological equilibrium and stability.

Is it wise to consider surgical corrections if another pregnancy is a possibility in the future?  

It depends.

If a woman wants to re-establish the breast fullness that she had during pregnancy, it would not be unreasonable to proceed with AUGMENTATION, even if another pregnancy is a possibility.  If residual skin laxity is also involved, a MASTOPEXY might also be considered (with the understanding that further tightening may be required after future pregnancies).  Finally, if undesired fullness and laxity are involved, a BREAST REDUCTION might be considered to alleviate symptoms such as neck and back pain, again with the understanding that a secondary procedure may be required after subsequent pregnancies.

Similarly, if a woman is left with only an excess of diet-resistant abdominal fat, Liposuction alone may be considered to restore the abdominal contour, even if future pregnancies are a possibility.  Similarly, a MINI-ABDOMINOPLASTY may be considered as a temporary solution for excess skin and fat that does not respond fully to diet and exercise.  On the other hand, it would be unwise to proceed with a FULL ABDOMINOPLASTY procedure if another pregnancy remains a possibility.  The remaining abdominal skin (which will already have been re-stretched by the surgical procedure itself) may be drastically over-stretched.  Furthermore, the mechanical repair of the rectus diastasis could be completely disrupted and undone, requiring more complicated secondary repair.  As such, this particular procedure is best delayed until no further pregnancies are planned. 

Optimizing Results

Diet and Exercise can do things that surgery cannot. Conversely, surgery can often do things that diet and exercise cannot. It is important to realize that the two often work synergistically with one another, not exclusively of one another.  

Eat better and smarter.  Fit exercise into your busy life as much as possible.  Lose as much of the extra ‘baby’ weight as possible and work on making yourself healthier in the long run.  And when the stretched out skin and stubborn lower abdominal fat is not getting any better in the mirror, do not get frustrated.  Do not feel guilty that you are “just not working hard enough”.  Realize that sometimes you just need a little extra help.  And that is what we are here for.

Stephen Lober Plastic Surgery in Athens, GA

Contact Stephen Lober Plastic Surgery to learn more about Mommy Makeovers in Athens, GA, and the surrounding areas. We’re happy to answer all your questions about your tummy tuck diet or set up a consultation.