Ask The Doctor

Life is full of gifts and although the addition of children to a family is wonderfully anticipated, the resulting changes to the mother's body often are not. Today's mothers agree that their families are their first priority but are also clear that the ability to recontour the body to the pre-pregnancy appearance is easier than ever before to achieve.

Breast Changes and Correction

The physical changes that can be addressed with Mommy Makeover breast rejuvenation are drooping breasts, large, sagging breasts or breasts that have simply lost volume. During pregnancy and lactation, the breast first prepares for breast feeding by the increase in size of the milk glands. The remaining fat in the breast shrinks and the skin capsule enlarges at the same time. When lactation is complete, the milk glands return to their normal size but the skin of the breast may be stretched and pre-pregnancy fat in the breasts is diminished. The woman is left with breasts that are less full and commonly have lost volume in the top of the breast, tend to sag lower than before the pregnancy and often will have developed stretch marks. Most stretch marks may fade out over time but the loose skin will contract minimally.

The procedures most often used in Mommy Makeover breast rejuvenation include breast augmentation alone, breast augmentation and breast lift together or breast reduction. During consultation, Dr. Hand will make individualized recommendations based on the loss of volume of the breast, amount of sag of the surrounding skin and the preference for eventual breast size. Sometimes when only a small amount of breast sag has resulted from pregnancy, breast augmentation as a corrective procedure is enough. Most often when a large amount of sag is present, a breast lift is indicated and a breast augmentation may be added if a fuller breast with more volume is desired. If the breast remains excessively large after pregnancy and lactation, a breast reduction may be indicated to remove part of the breast tissue and restore the breast to a volume that fits the body and has a more youthful appearance. Dr. Hand recommends that these procedures be done after the completion of one's family and 3 months or later after the completion of breastfeeding. Future pregnancies will recreate the hormonal influences that caused the stretching in the past. Newer techniques in breast surgery usually preserve the ability to breastfeed afterwards but cannot be guaranteed, particularly with breast reduction.

Abdominal Changes and Correction

Perhaps the most significant bodily change of pregnancy is seen in the abdominal muscles and skin. As a pregnancy progresses, the mother's hormones allow the abdominal muscles to relax. Small hernias are not uncommon, occurring because of the resulting separation of the muscles as the baby's size continues to increase. Sometimes, particularly in a youthful mother, the abdomen will return to its pre-pregnancy state but most often varying amounts of loose, possibly sagging skin occur. The woman may be left with stretch marks, particularly in the lower abdominal area and bulging muscles.

The procedures used for Mommy Makeover abdominal rejuvenation include tummy tuck (abdominoplasty), mini-tummy tuck and liposuction. The abdominoplasty procedure is performed in our accredited Marin County outpatient surgical facility. Dr. Hand commonly advises a regular tummy tuck for most women to remove the large pooch of skin and fat below the belly button to the upper pubic area, to tighten muscles and to remove underlying fat in the lower abdomen. The belly button is repositioned, lower abdominal stretch marks are removed, internal muscles of the upper and lower abdomen are tightened and the upper and lower abdomen regain the tight, toned appearance lost after pregnancy. The surgical incision is usually curved, extending from hip to hip under the bikini line above the pubis so that it will be hidden in a bikini. The scar is usually a fine line that continues to fade. When a woman has only a small amount of lower abdominal laxity, a procedure called a mini-tummy tuck may be utilized. It is a more abbreviated procedure in that only the lower abdominal muscles may be tightened slightly and the belly button is not repositioned. When a tummy tuck is not an option for a woman and extra skin is not an issue, liposuction is sometimes performed to remove fatty deposits to the abdomen, flanks, lower extremities and arms.

Abdominoplasty while being a wonderful solution to the issues that have been previously addressed, is a procedure that requires the woman has adequate help at home to deal with small children. Dr. Hand advises no lifting over 10 pounds for 2 weeks. Regular intense exercise may not be resumed for 4-6 weeks. Most women expect to need help with carpooling and daily activities for the first 1 to 2 weeks.

Although abdominoplasty can be performed earlier, Dr. Hand recommends that the procedure be performed 6 months or longer after delivery in order to allow the skin to maximally contract naturally.

Localized Fat Deposits and Correction

Very often, mothers find that their bodies continue to change for up to a year after pregnancy, but localized fat deposits tend to stubbornly stay. Liposuction is now performed in most areas of the lower extremities, abdomen, back, arms and neck. It is best used for the woman that at a consistent weight with localized fat deposits that are resistant to diet and exercise.

Dr. Hand can also perform most of the above procedures at the same time as tubal ligation or hysterectomy, in conjunction with the patient's obstetrician at the hospital. Multiple procedures can sometimes be combined and often are staged at our accredited Marin County outpatient surgical facility into 2 surgical days to allow for easier recuperation.

Other Options

Although in most cases Mommy Makeover involves body rejuvenation, other options to refresh the facial appearance are also available. Upper or lower eyelid surgery can revive the tired look many new moms justifiably experience. Mini-facelift and dermal fillers can freshen the beginnings of aging changes that do not match the woman's restoration of the body.