The first question that we need to answer is what exactly is a Mommy Makeover? Actually, the Mommy Makeover is not a specific operation but rather a combination of different surgeries a woman can undertake after having children to help restore her body closer to its pre-baby state.
Usually, it will be a Tummy Tuck and Breast Augmentation, often accompanied by a Breast Lift. However, you can also choose just the TT, or the BA, or a Breast Reduction and the Breast Lift. Oftentimes the Mommy Makeover can include a Liposuction to the flanks, bra area, hips, knees, pubic area, neck, or upper arms.
Other tools that can help fight the changes after a baby are Smartlipo, Cellulaze, and Sculpsure. Even newer still is a Picosure laser which can do a great job dealing with melasma and the irregular hyperpigmentation on the face, neck, chest, and hands, which occurs with pregnancy and just aging itself.
The vast majority of women experience some changes in their bodies after a pregnancy that cannot be totally reversible, even with a great diet and exercise. Breastfeeding frequently leads to a loss of upper pole volume in the breasts, oftentimes accompanied by droopiness (ptosis).
No amount of chest exercises can rectify this – only surgery. The Breast Augmentation with saline or silicone implants and sometimes the Breast Lift (there are several different types of lifts) is necessary too. Occasionally, only the 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 the 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. Almost always a silicone or a saline implant is placed under the pectoralis muscle. I 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 choose to do the 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 also on another part of your body, 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 the 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 and we will discuss this 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) can provide a great solution. Any fat deposit from the neck down can be treated with the Smartlipo as part of the Mommy Makeover.
The Smartlipo or Laser Lipo uses very small, 2-3 mm incisions with 1-2 incisions per treated area. I do it with local anesthetic and oral sedation. You need someone to drive and pick you up from the office. Through this incision, I introduce a small cannula and infiltrate the subcutaneous 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 cell membrane is damaged. There is also a temperature probe at the tip of the laser, ensuring that the correct amount of heating occurs. If things get too hot, the firing slows down and if it gets even hotter, then the entire laser machine shuts off.
I have done more than 1,000 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. I believe that a significant amount of the fat that is not removed by the Liposuction, is later resorbed by the body.
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.
I treated my flanks and I went to the gym with no problem, immediately after each session. 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 can include facial procedures such as a Blepharoplasty (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.
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.
BOTOX & FILLERS
Although not typically thought of as part of the Mommy Makeover, a Botox and Fillers help restore a more youthful appearance. As you can tell, there is no defined Mommy Makeover. It usually involves the breast and abdomen but really can also include any part of your body.