I guess Mother’s Day is a good time to talk about the term “Mommy Makeover.” The term is thrown around the media a lot. Reality shows are always making over someone. (In fact, our group was asked to participate in the makeover of a patient on 1 of the 1st reality shows. We turned down the request. We are private practice plastic surgeons who take all 4 of those words seriously!).
The sacrifices a woman makes to produce her children include the accommodation her body makes for the growing child. These accommodations are usually permanent and include loss of skin elasticity, striae or stretch marks, and a midline abdominal muscular separation called a rectus diastasis. Furthermore, the postpartum accommodations include engorgement of the breast tissue as the glands are activated to produce milk. Subsequent involution and collapse of the breasts’ shape are not uncommon.
The abdomen and the breasts, being the 2 most common areas of postpartum change in a woman’s body, therefore constitute the 2 main events in a “Mommy Makeover.”
Abdominal muscular separation, residual fat, and excess skin are all addressed during the abdominoplasty or “tummy tuck.” My partners, Dr. Sando and Dr. Aker, and I have evolved our technique over the last 25 years to include not only a muscular repair but a tightening of the muscles to give most patients a smaller waist. Most, but not all, patients lose an average of 4 dress or pant sizes. Other modifications include extending the incision around the side to elevate the thighs and buttocks, and the newest modification; our drainless technique, a series of extra quilting and tightening sutures internally which, in addition to making rubber drain tubes unnecessary, give a better cosmetic result, and take tension off the main wound closure, in our opinion.
These modifications have taken the standard abdominoplasty as a local operation for the front of the abdomen to a more holistic rejuvenation of the trunk. This creates more harmony and balance with the rest of the body.
The breasts change in shape over time. Factors such as weight gain and loss, both before and after childbearing, overall body and breast size initially, and the age at which the patient bears children mean the procedure required may vary from 1 patient to another. The solution for a breast too small for harmony with the rest of the body, or that has become too small after breast-feeding is over, usually involves placement of a breast implant. Since simple breast augmentation by breast implant cannot appreciably change the shape of the breast, just its size, it is important that the pre-augmentation breast be of fairly normal shape. Pseudoptosis or “fake sagging” is a loss of volume after pregnancy or weight loss which preserves the relationship of the nipple to the fold beneath the breast, called the inframammary fold.
In contrast, some breasts have truly age or sagged, what we call “ptosis” so that the nipple now lies at or below the inframammary fold. Breast implants alone cannot usually correct this problem of shape. Instead, a “lift” of some type is recommended. The degree of severity usually determines the extent of additional incisions on the breasts necessary to correct the problem.
Finally, the newest addition to the Mommy Makeover series is fat grafting; a patient’s liposuctioned fat can now be carefully processed by washing, filtration, and then injecting into the breast to re-inflate a deflated form. This can be done with the buttocks as well. Fat grafting is frequently done along with other procedures, including liposuction to enhance the result of implant augmentation mammoplasty, abdominoplasty, and other body contouring procedures. If it is to attempt to replace breast implants alone, then several fat grafting operations are usually required, depending on the patient’s desire for volume in the breasts.
At the end of the day, we want the patient and ourselves to feel the result looks more normal than the preoperative condition did. The distraction is gone, normal is absolutely beautiful!