Mommy Makeover

What does mommy makeover correct?

Many changes occur to the female torso with pregnancy. The popular term describing the surgery to enhance the breasts, abdomen and thighs after pregnancy is called a “mommy-makeover.”

Of course, every woman is different, and the changes that occur after pregnancy are extremely individual. Some women will need implants or fat grafts to enhance the size and shape of “deflated” breasts. Other women will request a reduction and reshaping of their breasts, called a mastopexy. Everything depends on the location of the nipple. With pregnancy, the natural swelling of the breasts causes the skin envelope to enlarge and the delicate suspensory ligaments holding the nipple in position to lengthen. After the baby is born and lactation is over, the breasts decrease in size, sometimes smaller than the original size of the breasts before pregnancy. The breasts are said to be “deflated” and the stretched skin and suspensory ligaments do not retighten. These changes cause the nipple to descend in many women. A nipple located at or below the fold of skin where the breast meets the chest will need to be raised in some manner — either with the process of a mastopexy, or else refilling the size of the breast with a large implant. Sometimes, a mastopexy is combined with placement of an implant.

Abdominal rejuvenation is achieved with an abdominoplasty. The growing baby causes a natural stretching of the stomach muscles. The vertically oriented rectus abdominis muscles move away from each other — a condition called rectus diastasis or diastasis recti. The skin is sometimes permanently stretched, and the elasticity of the skin is not enough to return to the pre-pregnancy tightness. This causes the skin to sag or be more easily pinch-able. Finally, the skin and fat itself can have microtears called striae or stretch marks. Stretch marks are located typically around and below the umbilicus — where the skin stretching from pregnancy is the most marked. Abdominoplasty involves the tightening of the abdominal muscles and skin with surgery.

Pregnancy changes many contours, including the shape of the inner and outer thighs. Liposuction using thin cannulas can be used to reshape and smooth thighs and buttocks that enlarged at the time of pregnancy and stubbornly refused to reduce in size despite diet and exercise.

How do I get back my pre-pregnancy waistline?

Women having their first child, who gained less than 30 pounds and who have good elasticity in their tissues can indeed return to their pre-pregnancy waistline when they get back down to their original weight.

The growing fetus slowly stretches the lower abdomen and causes many changes. The uterus enlarges, and expands the abdomen. First, the lower abdominal wall begins to stretch. By full term, the entire abdomen has gone through a considerable change with thinning and widening of all of the tissues. The linea alba is the tough fascia between the rectus abdominis muscles. As it stretches, it widens from the width of the little finger to even three inches wide in the worst cases of rectus diastasis. The muscles themselves thin and widen. Some women carry their babies straight forward — accentuating the amount that the rectus muscles are thinned and widened. Twin gestations do the same thing by dramatically forcing the abdomen to enlarge.

At the time of childbirth, there are natural hormones (relaxins) that soften the tough connections between the pelvic bones. The pelvis itself shifts to allow the baby to be born through the vagina. These bony shifts may cause permanent changes in the pelvis — a prime reason that the pregnancy waistline may NEVER return to the original shape and size.

After pregnancy, it takes time for the stretched muscles and linea alba to move back toward their pre-pregnancy sizes. It is easier for the tissues to shrink after the first pregnancy in comparison to subsequent childbirths. Core exercises such as planks and Pilates are helpful for the abdominal muscles to regain tone. Breastfeeding helps a new mother regain her pre-pregnancy weight. Finally, some women are blessed with excellent tissue elasticity, leading to a regaining of their pre-pregnancy waistline.

How do I lose belly fat?

Everyone is born with different patterns of fat cells. When comparing men and women in their distribution of fat, men have more fat inside the abdominal muscles, while women have a higher percentage of fat outside of the muscles where it can be measured with a “pinch” test.

The tried and true way to lose belly fat is to lose weight. Less calories ingested and more energy expenditure will lead to weight loss, and some of that fat will be from the abdomen.

For people wishing to improve a particular contour or shape, liposuction can be used to decrease fat thickness. However, it is not weight loss, and patients typically will weigh the same after liposuction in comparison to just before surgery. Surgical removal of fat with an abdominoplasty is a more marked change, but still results in only a few pounds of fat tissue being removed typically.

Can I have a tummy tuck immediately after a Cesarean section?

This is typically not recommended. No matter how enticing the idea to restore abdominal shape immediately after pregnancy with surgery, there are several reasons not to seriously consider this procedure. The uterus is enlarged, and prevents tightening of the muscles and skin. The tissues have increased blood flow, and so the blood loss would be greater than a standard abdominoplasty. Finally, the focus of a pregnancy and delivery must be the baby, without any added risks or distractions.

What will fix my sagging abdomen/tummy?

There are four ways to improve the shape and contours of the abdomen. Weight loss to a healthy baseline level causes a thinning of fat between the abdominal muscles and the skin in women. This shows up as an improved “pinch test” on the flanks. Men, with their “beer bellies” have more fat inside the abdominal wall than outside, and their weight loss shows up as less central abdominal bulging, but usually their “pinch test” is less dramatically improved than for women.

Exercise is good to help tone muscles and to keep off unwanted pounds. The exercise should be a combination of aerobic workout aimed at increasing the resting heart rate, as well as exercises such as planks or Pilates that tone the abdominal wall muscles specifically. Increasing the abdominal wall muscle tone improves the overall abdominal shape.

While there is no substitute for diet and exercise, liposuction of the abdomen and abdominoplasty or tummy tucks each have specific indications to improve a sagging abdomen/tummy. The goal of liposuction is to improve contours. Rather than having an upper abdominal bulge or overhanging fat when one puts on tight jeans, liposuction can work to improve these shapes. Multiple poke holes located in easy-to-hide areas such as the shadows of the umbilicus are used to suck out unwanted and thick fat located around the belly button, the upper abdomen and the flanks. Liposuction can even be done on the lower back roles with an excellent improvement in shape.

Abdominoplasty is one of the most successful cosmetic surgeries performed. The primary indication for this surgery as opposed to simple weight loss, exercise or liposuction is stretched-out skin or abdominal muscles after pregnancy or significant weight loss. Rectus diastasis is the separation of the rectus abdominis muscles from each other. Rectus diastasis that fails to improve over time after childbirth is another indication for abdominoplasty. Abdominoplasty typically involves two components — tightening the stomach muscles, and contouring the skin. Additional benefits of abdominoplasty include improving a sense of “core”—some women have improved stability and less back pain after surgery. Stretch marks are often located between the umbilicus and the pubic hair — this is the skin removed in an abdominoplasty.

What causes stretch marks, and what can be done about them?

Stretch marks, or striae, are caused by a rapid stretching of the skin, typically due to pregnancy or significant weight gain. The dermis of the skin, located directly under the superficial skin cells, suffers numerous microtears. Stretch marks occur where the skin is most stretched and the dermis is weakest — typically in the area of skin centered around the umbilicus.

There are no established treatments to prevent stretch marks, nor are there any creams scientifically shown to cause them to disappear. Surgery, or abdominoplasty, is the only way to remove stretch marks. Typically, the skin located between the umbilicus and the pubic hair is removed with abdominoplasty, and this is the site where 75 percent of the abdominal stretch marks exist. The remaining stretch marks, initially located above the umbilicus, are moved downwards with surgery to remain easier to conceal near the incision at the pubic hairline.

Contact Dr. Dumanian

If you’d like to speak with Dr. Dumanian about your personal mommy makeover goals, please contact him and schedule a one-on-one consultation. Call 312-695-1999 or email him today.