A Mommy Makeover is a plastic surgery approach that addresses the physical changes a woman experiences during and after childbirth. The areas most commonly treated are the abdomen, hips, and breasts. Many of my patients want to reverse some of the effects pregnancy has had on their bodies and get back closer to how they looked and felt before.
Why a Mommy Makeover May Be Needed
During pregnancy, hormones drive significant changes in a woman’s body to prepare for birth and the care of a newborn. These changes often include weight gain, enlarged breasts, and a relaxing of the ligaments in the abdomen and hips, changes that don’t always reverse on their own after delivery.
Areas That Are Treated
Abdomen
When the abdomen is enlarged from fat alone, above the abdominal wall, liposuction may be all that’s needed. If there is also excess skin, an abdominoplasty (tummy tuck) is needed to remove the extra skin and fat. In thin, fit patients, this may be all that’s required.
If the abdominal wall muscles are also separated, a condition called diastasis recti, which is common after pregnancy, the abdominal wall must be tightened. The muscles themselves are not cut; they are sewn together in the midline with non-absorbable sutures. Hernias are also common in these cases. A hernia is a weakening in the abdominal wall that allows the abdominal contents to push through, and over time these can enlarge and become dangerous if bowel becomes trapped, leading to strangulation. I repair these at the time of a tummy tuck by sewing the widened area between the two vertical muscles together, without cutting the muscles.
After the muscles are repaired in the midline, I position the patient sitting up and remove the excess fat and skin. The remaining fat between the skin and abdominal wall is thinned as well. Liposuction can be performed in the surrounding areas, but must be approached carefully so as not to reduce blood flow to the overlying skin that has been undermined. I place a pain pump to deliver anesthetic to the area for the first three days after surgery. The thin tube is removed easily once it’s no longer needed. I also block the nerves near the muscle repair with a long-acting anesthetic that lasts 6–10 hours, and place a drain for the first week to help remove fluid and speed healing.
Breasts
Breasts that appear smaller after childbirth and breastfeeding often show a deficit in the upper-outer area toward the armpit. This can often be improved with a breast implant, with or without a lift. Breast shape is determined by the amount of breast tissue and fat, along with the skin “bra” that holds everything in place. In many women, an implant alone is enough to address the shape change; in others, a lift is needed alongside the implant. I discuss this decision thoroughly with each patient, based on her individual anatomy and her tolerance for scars.
In a smaller group of women, the breasts have become quite large under hormonal influence and breastfeeding, and a breast reduction is the better option. Reduction can often preserve the ability to breastfeed in the future if another pregnancy occurs. I typically counsel women who are considering having another child to wait on a reduction until after they’re done growing their family.
Hips and Flanks
Excess weight carried in the hips and flanks is addressed with liposuction, typically performed at the same time as the abdominal and breast procedures.
How Long Does Recovery Take?
Recovery depends on which treatments are combined. The two procedures with the longest typical recovery are breast augmentation and a muscle-tightening abdominoplasty, since both involve the muscles, which leads to more post-operative soreness.
- Tummy tuck (abdominoplasty): Discomfort can last up to six weeks, since the central abdominal muscles (rectus abdominus) are involved in nearly every movement. Sitting up, twisting, stabilizing the abdomen to move other muscles, and especially coughing and deep breathing. The discomfort eases over a few weeks and typically resolves fully over a few months.
- Breast augmentation: This involves working around the large chest muscle (pectoralis major) just above the breast crease when creating the pocket for the implant. For most women, this discomfort lasts only a few days, since their chest muscles aren’t heavily developed. It can take a bit longer for athletic women. I typically discourage sub-glandular augmentation, as it tends to lead to poorer results over time, since the weight of the implant can stretch the skin downward.
- Liposuction: Soreness for a few weeks, depending on how much fat is removed.
What Are the Risks?
All surgery carries risk, and we work to keep the anesthetic and surgical risk as low as possible. Advances like short-acting anesthesia drugs, the pulse oximeter (which measures blood oxygen saturation in real time), and computer-assisted monitoring have greatly reduced anesthesia risk. General risks with any surgery include bleeding, infection, and noticeable scarring. Risks specific to each procedure involve scar placement, possible implant issues such as position or internal scarring, and prolonged sensory changes. We work to minimize these through surgical technique and post-operative care.
Safety
I use intermittent compression of the lower extremities during surgery to help prevent blood clots, along with blood thinners where appropriate afterward for the same reason. The surgery is performed efficiently to limit time under anesthesia, and patients are encouraged to walk early after surgery and care for their incisions in a way that minimizes scarring.
Where Is the Surgery Performed?
We have our own Quad-A certified operating rooms (accredited by the American Association for Accreditation of Ambulatory Surgery Facilities) in our Bethesda, MD office, and we use only board-certified anesthesiologists. After years of operating in local hospitals, we’ve also been able to bring some of the best OR staff we’ve worked with into our own practice.
Experience Matters
I have been a plastic surgeon since 1989 and have performed thousands of operations. Over the years, I’ve encountered many situations that could complicate outcomes and developed ways to avoid them. My philosophy is to be appropriately aggressive without pushing the envelope to the point of jeopardizing my patients’ health. You can read more about my background here.
How to Learn More
I invite you to contact my office to learn more and schedule a consultation. You can also see real patient results in our mommy makeover before-and-after gallery.
Article by Dr. Arthur Jabs, board-certified plastic surgeon in the Washington, D.C. metro area, specializing in deep plane facelift and natural facial rejuvenation.
