The term “Mommy Makeover” refers to a combination of surgeries that help restore a woman’s body to its pre-baby state. While the term is commonly used for women who have had children, it can also apply to anyone who wants to undergo a combination of cosmetic procedures. The most common procedures included in a Mommy Makeover are Tummy Tuck and Breast Augmentation, often accompanied by a Breast Lift. Other procedures that may be included are Liposuction, Smartlipo, Cellulaze, Sculpsure, and Picosure laser.
Most women who have been pregnant experience changes in their bodies that cannot be reversed even with strict diet and exercise. For example, breastfeeding frequently leads to a loss of upper pole volume in the breasts, oftentimes accompanied by droopiness (ptosis). Surgery is the only solution for this. Breast Augmentation with silicone implants (saline implants can also be used, however, in 2023 most women will opt for silicone because of its advantages) and sometimes a Breast Lift (there are several different types of lifts) is necessary too. Occasionally, only a Breast Lift is required.
HOW DO YOU KNOW WHAT OPERATION YOU NEED FOR YOUR BREASTS?
There are a few basic considerations.
Firstly, is your current breast size what you want? When you are in a bra, do you feel your breasts are too big or too small or just right? If they are too large, then you should consider Breast Reduction – this can remove a large amount or a small amount. This will almost always include the Breast Lift as part of the Breast Reduction.
BREAST AUGMENTATION & BREAST LIFT
If your breasts are too small, then you will want to consider the Breast Augmentation as part of the Mommy Makeover. I strongly prefer placing the implants under the pectoralis muscle. I also strongly prefer a silicone implant because it feels more natural and is less likely to show any rippling.
Everyone after the BA will have upper pole swelling that will last at least 3 months and sometimes longer if you do a Breast Lift at the same time. You need to stop breast-feeding and then wait for your breast size to stabilize (they may continue to decrease in size after breast-feeding is completed). You also need to have any milk leakage stopped. For most women, this will mean waiting about 3 months after you totally cease breast-feeding. After a straightforward BA, you can return to work after 3-4 days. However, if you have surgery on another part of your body as well, such as the Tummy Tuck, then your return will be delayed. I usually let you resume some types of exercise after one week.
BREAST REDUCTION & BREAST LIFT
If you require the Breast Reduction, then I will usually do an anchor incision. This allows me to elevate the nipple-areolar complex while leaving it attached to your body. Almost always sensation is retained, though temporarily you can have either too much or too little sensation in the nipple-areolar complex. All of the scarring is hidden by a regular bra or bathing suit top. This usually gives a great shape. The scarring will fade with time. This is done under general anesthesia at the Surgicenter.
Sometimes in the Mommy Makeover, you just need a Breast Lift – either on its own or as part of the Breast Augmentation. There are several different types of lifts. If you need only a small lift, or the breasts are small, I can carry out a donut mastopexy. This allows us to hide the incision around the areola. It is also an opportunity to decrease the size of the areola.
If there is a greater degree of ptosis (droopiness) then I can do either a vertical mastopexy (lollipop incision) or a full anchor incision. There are advantages and disadvantages to each approach, which we will discuss at your consultation. Almost always full sensation will be retained but cannot be guaranteed.
Sometimes the pregnancy can cause a redistribution of fat. If the skin tone is satisfactory, a Smartlipo or Sculpsure (non-invasive melting of fat in 25 minutes done in the office. 2 sessions of Sculpsure are required) can provide a great solution. Any fat deposit from the neck down can be treated with the Smartlipo as part of the Mommy Makeover.
In 2023, Smartlipo remains a great option because it is done in the office with just oral sedation and local anesthetic. Many people like the option of avoiding a general anesthetic. The Smartlipo or Laser Lipo uses very small, 2-3 mm incisions with 1-2 incisions per treated area. You will need someone to drive and pick you up from the office. Through this incision, I introduce a small cannula and infiltrate the subcutaneous tissue with a local anesthetic. No one is resistant to lidocaine and everyone will get numb. The solution also has epinephrine which decreases any bleeding and bruising.
After this, I insert a small laser fiber connected to a very powerful, but very safe laser. Every time that I step on the pedal, 2 different wavelengths of laser emerge and it is highly specific for fat. Fat is very sensitive to heat and the fat is either vaporized or melted. There is a temperature probe at the tip of the laser, ensuring a safe temperature.
I have done more than 1,500 Smartlipo cases and I have never caused a burn. After the fat is melted, it is liposuctioned away. The Smartlipo is less uncomfortable than a regular Liposuction because the skin gets temporarily numb after the treatment and this lasts for several days.
There is some degree of skin tightening after the Smartlipo but this varies depending on the age and native skin tone of the patient and also the area of the body. You will usually continue to improve for 6 months after the Smartlipo. I stress to my patients that it is a partnership and that if they want the best results, then they should work on decreasing their body fat (see my blogs under the ketone supplement section, under procedures).
A Sculpsure or Warm Sculpsure (in contrast to the less effective Coolsculpting) uses a laser light that penetrates the skin and heats the underlying fat. It works on the same principle as the Smartlipo but does not require an incision or local anesthetic. It is less aggressive than the Smartlipo and does not require any incisions.
At least 2 treatments are required, done 4-6 weeks apart. Each treatment session consists of 4 paddles (about ¾ of the size of your hand). Each treatment session only takes 25 minutes so it is very common to treat multiple areas at one office visit. You can return to work immediately after the treatment.
The treatment is FDA approved. A Cynosure laser demonstrated a 24% fat reduction but results definitely vary from person to person and area to area. Once again, there is no magic and if you want to get your best results, you need to combine this with better dieting to decrease your total body fat.
You definitely feel the heat. The esthetician can give you up to 4 one minute breaks, where the paddles go from very warm to cold. In addition, if you are still sensitive, then we have a Nitronox system (basically it is “laughing gas” ) and you can still drive yourself since it is very short-acting.
If the skin tone is significantly decreased or there is a significant stretching of the abdominal muscle fascia, then it is worthwhile to consider the Tummy Tuck in your Mommy Makeover. This is done under general anesthesia at a wonderful Surgicenter that I use in Mclean.
You can return to work in 10-14 days, though I have had several patients return in 5-7 days. I often can carry out the TT without placing any drains, but this will be discussed at your consultation. You can shower the next day and I want you up walking immediately after surgery. You will have to eat all your meals at the table and not in bed.
The Mommy Makeover may also include facial procedures such as a Blepharoplasty (an eyelid procedure that often makes you look less tired) which is done in the office. You can return to work in 2 days. You need to apply ice for 2 days after the Blepharoplasty and the single suture is removed about 6 days after surgery.
The Picosure laser facial will significantly improve facial/neck/chest/arm discoloration or melasma (the hyperpigmentation that occurs with pregnancy). Plan 3 sessions each a month apart. You cannot do this when you are tanned. This laser is particularly advantageous with any women who have any ethnicity to their skin color. This laser is much less likely to cause hyperpigmentation after treatment, than any other treatments.
My wife has had fantastic results from doing a series with the Picosure laser to improve her hyperpigmentation on her face, neck, and chest, and then she did a series of microneedling with PRP to really make her skin glow (once again a series of 3 treatments each a month apart). Some patients will set up every two weeks, alternating treatments between Picosure laser and Microneedling with PRP.
A mommy makeover is a highly personalized set of procedures that can help women regain their confidence and feel more satisfied with their bodies after pregnancy and childbirth. From breast lifts and augmentations to tummy tucks and liposuction, the specific combination of treatments will vary depending on the individual needs and goals of each patient. I very much enjoy working closely with my patients, hearing your concerns and expectations in detail and feel great satisfaction as I help you regain confidence and comfort in your own body.