Mommy Makeover

By Dr. Robert Clement – March 1, 2012

After childbirth, women look at their bodies with amazement at the changes that occurred due to the pregnancy. Many people will tell you that if you just work hard enough and diet, your body will be restored to its 18-year-old status. This will never happen. There is no series or set of exercises that can correct the stretching in the breasts or abdomen that occurs with pregnancy.

Following pregnancy, many mothers ask the questions, "Should I do something to regain my shape? If so, what, and when should I do it? What if I am planning another pregnancy?" My answer is to wait until you have had all your babies. If you get pregnant after you have a surgical correction, you will come back to have at least a portion of your breast or tummy redone due to the changes with that pregnancy. It’s also important to wait an appropriate amount of time after pregnancy before undertaking a procedure. Your tissues require a minimum of six months after delivery to shrink and regain their pre-pregnancy status, and intervention prior to that time can lead to unsatisfactory results.

During pregnancy, four things can happen to the breasts: they can shrink, they can sag, they can sag and shrink, and (ever so rarely) they may not change. Changes are due to the thickening of the glandular and ductal tissue in the breast associated with weight gain during pregnancy. Following pregnancy and/or breastfeeding, the glandular tissue and ductal tissue may resume their pre-pregnancy status or even shrink to smaller than their pre-pregnancy status. The skin has been stretched because of the massive increase in ductal tissue and additional weight during pregnancy, and this leads to sagging of the breast (ptosis).

There are basically three types of breast surgery (mastopexy) that can be used to correct sagging.

1. A circumareolar mastopexy results in a scar just around the areolar complex, the pigmented portion around the nipple.

2. A “lollypop” mastopexy results in a scar that circles the areolar complex and then goes down to the inframammary fold (or crease where the chest and breast meet).

3.The third type of mastopexy results in what many people know as the “anchors” scar, which is around the areolar complex down to the fold and then in the fold itself.

Unfortunately, there is no way to raise the breast with a mastopexy of any kind that does not leave some scar. However, the quality of the scar in most cases is very good, and it often becomes essentially a small white line after six to twelve months. Some have suggested inserting a large implant will lift the sagging breast to its original status. I have both seen and experienced many of these procedures where the placement of the implant results in fullness at the top with skin sagging off the bottom of the implant, worsening the condition.

Recovery from a mastopexy of essentially any type is approximately the same time duration. You can usually do most normal activities such as daily driving, household duties, and work (if it does not require heavy lifting) within one or two weeks. Hard, vigorous activity should be postponed for at least four weeks, and at that time, you should wear a very strong, supportive bra.

The risks that can occur with mastopexy are similar to any other operation. If the mastopexy includes placement of an implant, there is an additional risk of capsular contraction. A capsular contraction means that a pocket has been created around the implant which can shrink, causing the implant to feel either slightly firm or very firm. This can also change the configuration and shape of the breast. This occurs about three to four percent of the time.

Abdominoplasty is a significantly more involved operation. The anatomical entities that have to be corrected are the tightening of the fascial covering around the muscle, reduction of the fat on the stomach, and resection of the excess stretched skin. There are several types of tummy tucks: a full tummy (liposuction, repair of the muscular defect, and resection of the skin) and a modified tummy tuck (less skin removed and the belly button only moved down but also the fascia or muscle is tightened at the same time). In very few patients, an operation called a skin-only abdominoplasty can be done; liposuction is carried out to reduce the fat and the excess skin is removed, but there is no tightening to the fascia wall. This procedure occurs only in a very unique anatomical situation, as I rarely see postpartum patients who do not have stretching of the fascia. Why? The fascia surrounding the sac in which the muscles live looks very much like an over-stretched rubber band or balloon after pregnancy and no matter how many exercises you do to tighten the inner muscle, that covering remains the same. This is why you still have the belly bulge even though the muscles are in wonderful shape. I had a patient who did 1,000 sit-ups on an inclined board everyday but could not change the contour of her abdomen because of the fascial tightening.

While abdominoplasty is not the most uncomfortable operation we perform, it is still significantly painful. Following surgery, we use pumps that deliver local anesthetic for about four days. We also give heavy narcotics to those patients and ask them to use a walker to get around for the first four to five days to decrease the amount of pain in the abdomen. Recovery for the tummy tuck is significantly longer. Activities are very limited for the first two weeks, much like following a Caesarean section. I’d rather you not drive for those two weeks. After the third week, you can start taking short walks. At four and five weeks, increase the length of those walks or get on an elliptical trainer with no resistance and begin to exercise. Light weight work is okay at four and five weeks, but there should be no abdominal exercise for six weeks. This eliminates the potential of a tear in the fascial repair, which would result in a bulge that usually requires surgical repair. The potential risks following the abdominoplasty are those common to other surgical procedures, which include bleeding, infection problems with the skin, and pulmonary emboli.

The good news is that, if you continue to exercise with some regularity and watch your weight, the contour will remain flat for 15 to 20 years following the tummy tuck. I have seen many patients who at 15 to 20 years post-procedure still look very flat and very good in their clothes. While a “mommy makeover” is not a perfect operation, it can restore ninety percent of the pre-pregnancy state that has been devastated by the changes occurring during pregnancy.


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