“Mommy Makeover” usually refers to procedures that combine breast reshaping and body contouring.
Society places a premium on appearance and youthfulness and pregnancy may alter a woman’s body. Top rated Los Angeles surgeon, Dr. Timothy Neavin, believes many women feel that child bearing has changed their body and want to return to their previous look. Others want to go back to work feeling confident about their physical appearance and shape. Even though dieting and exercise may provide physical benefits for most mothers, some may be left with unwanted changes, such as, loss of upper breast fullness or form, loose abdominal skin, and stretch marks. These are changes that can be usually improved only with surgery. Procedures that address many of these concerns at one time are at the heart of “mommy makeover” surgery.
“Mommy makeover” usually refers to procedures that combine breast reshaping and body contouring. Breast are reshaped by either making them larger and lifting them or, on other occasions, by reducing their size. Body contouring procedures will depend on the amount of skin flaccidity, stretch marks, the loss of abdominal wall tone, and on the localized areas of fatty accumulation that remain despite weight loss and exercise. These can consist of skin removal such as a tummy tuck or abdominoplasty, liposuction, or a combination of both. If women are healthy, procedures that address these concerns can safely be done simultaneously allowing for just one recovery period.
Pregnancy can induce changes to the appearance of the breast and belly. Often, these changes are permanent and improve little after giving birth.
As a general rule, the later in age that these changes take place, the more difficult it is for the body to return to its prior state. The breasts engorge with milk during the process of lactation during pregnancy. As the breasts enlarge, the tissues stretch. Depending on the native elastic properties of one’s tissue, the breasts may or may not return to a perky state after the cessation of lactation. For many women, their breasts after pregnancy are left looking flat and deflated. They have lost their youthful, perky appearance. The abdomen also follows similar rules which will be discussed later.
“The deflated breast” after pregnancy
Envision a beach ball. Now a balloon. Fill both up with air until they almost pop, then slowly remove air. The balloon will remain tight throughout most of this deflation. The beach ball will soon look wrinkly and lose its round shape. The reason behind these difference relies on the properties of elasticity. You have probably already caught on to the analogy that the balloon is a young woman and a beach ball is an older woman.
If you have tight, elastic tissues, there is a reasonable chance your breasts will “survive” a pregnancy without a permanent, deflated appearance. However, for most women this is not the case. In the latter example of the beach ball, there are two ways to restore a round, tight appearance. One would be to add more air, and the other would be make the beach ball smaller. That is, change the volume to surface area ratios.
One of the most powerful operations in plastic surgery is a breast augmentation of the deflated breast of pregnancy. Many women who have had beautiful, round and perky breasts miss their appearance in a bikini or bedroom. Often, women will think that their breasts are now “saggy” or droopy. However, most often, breast changes after pregnancy are simply volume and skin area mismatches. Simply adding more volume with a breast implant frequently restores their breasts to a perky, pre-pregnancy state.
In less frequent cases, an implant alone cannot achieve the pre-pregnancy look. In these less common cases, a lift may be required to raise the nipple and remove extra skin.
The options for breast shape improvement after pregnancy include:
- Breast augmentation
- Breast lift (mastopexy)
- Breast augmentation with mastopexy
Breast augmentation for the post-pregnant woman should be timed appropriately. After pregnancy, there is a period of lactation that may last several months or longer during the period of breastfeeding. If one doesn’t breastfeed, lactation should end spontaneously. Once lactation subsides, the breast will need to slowly return to their pre-lactation state. While the breasts shrink, the skin often doesn’t follow completely. However, before proceeding with volume addition as in a breast augmentation, it is wise to wait 3-6 months following lactation to ensure that the breast has stopped contracting. Prematurely operating on a breast with residual lactation will result in suboptimal shape and may even contribute to infection or capsular contracture.
Often, the breasts will result in a smaller shape than the pre-pregnancy state. It is not uncommon for women to choose implants to achieve breasts even larger than their pre-pregnancy state. Implant choices include silicone or saline breast implants. Both have their own set of advantages and disadvantages in the deflated breast after pregnancy.
Silicone breast implants for the deflated breast after pregnancy
Silicone tends to look and feel more natural than its saline cousins. The properties of silicone are softer, and behave more like breast tissue than saline (salt water). Thus, one would think that silicone should
always be the superior choice to breast augmentation. However, this shortsighted thinking will occasionally result in suboptimal results. Silicone, because it is softer and behaves more like breast tissue under the influence of gravity, may not “lift” the breast as much as an overfilled saline breast implant. In women with reasonably full breasts, saline breast augmentation is often the best choice to restore perkiness in a breast if there are no plans to remove skin with a mastopexy. However, in women with more mild deflation, thinner tissues, and smaller breasts, silicone breast implants may be the most appropriate choice.
Saline breast implants for the deflated breast after pregnancy
Saline breast implants are often over-filled to create a more solid, and rounder implant than its silicone cousins. The disadvantages to this are probably obvious. The breasts will feel more firm than non-augmented breasts or silicone augmented breasts. However, if the breasts are large enough, the breast tissue can pad the implant. The advantages to an overfilled breast implant is that it can fill the upper pole of the breast better than silicone. Much of the deflation that occurs after pregnancy occurs in the upper portion of the breast. Larger, over-filled saline breast implants may be the perfect choice for this scenario.
Over the muscle versus under the muscle for mommy makeover breast augmentation
While it is true that most breast augmentations are performed in a submuscular fashion (under the muscle), the post-pregnancy breast sometimes can benefit from a subglandular (over the muscle) approach. Deflated breasts can develop “pseudoptosis”, which is a fancy word for a type of breast droopiness where the nipple stays high in relation to the saggy breast. True ptosis, or saggy breasts, is a condition where both the nipple and breast have descended below the fold of the breast. In pseudoptosis, a subglandular approach can elevate the breast tissue more than a submuscular approach. In women with ample breast tissue, this may be their preferred approach. Or, a dual-plane approach may be performed. This is a method where the breast implant is placed under the muscle but the breast tissue is still elevated off the muscle.
There bottom line is that there is no cook-book recipe for beautiful breast augmentation after pregnancy. Every woman must be evaluated properly to find the perfect fit.
Breast lift (Mastopexy) in the Mommy Makeover
Deflated breasts after pregnancy are a condition where there is too much skin for volume. If the desire is to restore a perky shape without increasing volume, then a breast lift or mastopexy is the appropriate operation. There are several different types of breast lifts. The details of these different approaches can be found in the breast lift section of this site. In short, the more lift required to form a perky breast, the more skin needs to be excised. The more skin that needs to be excised, the more incisions will need to be made. Thus, the essence of breast lift surgery is to trade shape for scars. Important in this philosophy is this: If one can reduce the volume and skin discrepancy with the addition of volume, then it is possible to reduce the amount of skin excision (and scars). That is, sometimes even the addition of a small breast implant can obviate the need more large incisions. This should be addressed during your consultation.
Breast lift with breast implant: Breast augmentation with mastopexy
Breast lift with enlargement using breast implants is a popular procedure among women who have had children. Women miss the fullness and perkiness of their breast. The combination augmentation-mastopexy is often the perfect choice to satisfy their desire to return to the beautiful breast of youth.
There are generally 4 types of breast lift procedures:
- Breast lift with implant alone
- Breast lift using peri-areola approach (Benelli lift)
- Vertical breast lift, or “lollipop lift”
- Inverted T, “anchor”, or Wise-pattern breast lift
Breast augmentation to lift breast
As mentioned above, a breast implant alone can result in a lifting of the breast. This type of lift naturally results in the smallest incisions and least noticeable scars. However, women with advanced deflation or sagginess may not be a suitable candidate for the breast augmentation lift. In this population, additional incisions will need to be made to not only improve the skin and volume ratio, but to also lift the nipple to a higher position on the chest wall. Breast implants alone cannot alter nipple position more than 1 or 2 centimeters in relation to the breast fold.
Breast lift using peri-areola approach (Benelli lift)
The Benelli or peri-areola approach describes a breast lift where the extra skin is excised around all sides of the areola. This approach leaves the scar around the areola camouflaged between the lighter and darker skin of the areola. It also affords the ability to raise the nipple 1.5 to 2 centimeters. The limitations to the procedure lies in the tension placed on the incision around the areola. With too much skin excision, the scar and areola will widen. The second major limitation to this approach is the change breast shape. Because skin is excised around the areola, the result is a flattening of the breast. Small reductions of skin won’t alter shape too drastically, and the trade off of shape to scars works. However, at some point the flattening of the breast will be more unattractive then a vertical scar. That is the threshold the patient and plastic surgeon must evaluate individually. In cases where a nipple must be raised more than 2 cm, it is wise to move up the ladder to the vertical breast lift. The addition of the vertical scar attached to the areola scar will result in a more powerful lift and improved breast shape.
Vertical breast lift or lollipop lift
The vertical breast lift is a Benelli or peri-areola lift attached to a vertical scar running from the areola to the breast fold. The addition of this vertical scar greatly improves the surgeon’s ability to shape the breast and increase the projection of the nipple from the chest wall. The vertical lift may result in a funny looking breast for the first month or two as the tissues settle and relax. However, for many women, this temporary inconvenience outweighs the addition of a horizontal scar as in the case of the anchor lift. About 25% of vertical lifts will need some type of revision to improve the scar. Of these, about half will still need the addition of a horizontal scar (albeit small) to improve shape.
Inverted T, “anchor”, or Wise-pattern breast lift
The addition of a horizontal scar running along the breast fold describes this procedure. The Inverted T or anchor breast lift is reserved for very droopy breasts that require a substantial lift. In most of these women who benefit from this type of lift, the nipples are low, sometimes pointing down. The breast mound has dropped quite a bit on the chest wall. The addition of the horizontal scar affords a very powerful means to reshape the breasts into the most perky shape possible. For most women who have this type of breast lift, the new, beautiful shape of the breast far outweighs the scars. The scars in the inverted T are well hidden in the fold, around the areola. And because the nipple sits right above the fold, the vertical scar is often not visible unless one is lying on her back.
The muscles of the abdominal wall called the rectus abdominus stretch from the midline as the pregnant belly enlarges to accommodate the growing baby. Because they are stretched for months, the elastic properties are changed. In many cases, the muscles do not return to the midline after birth. This is called diastasis. Exercise will not bring the muscles back to the midline. As a result, all of the exercise in the world cannot tighten the abdomen to the pre-pregnancy state. And all of the skin excision in the world will not flatten the belly as tight as it can be without the addition of a rectus plication. A rectus plication is the sewing together of the two rectus abdominus muscles at the midline. This is a very powerful abdominal rejuvenation technique that cannot be accomplished with exercise or diet.
In addition, the skin will have also stretched during these 9 months. Stretch marks and permanent, saggy skin become the rule. Liposuction and weight loss will not improve this appearance. In fact, they often exacerbate it. For women who desire a flatter tummy after pregnancy, tummy tuck or abdominoplasty is the gold standard. Abdominoplasty will tighten the muscles and remove saggy skin.
Abdominoplasty or tummy tuck
The greater the amount of saggy skin, the longer the incision will have to be made along the bottom of the belly. The incisions for this part of the procedure should be placed in a hidden area behind underwear or bikinis. The tummy tuck is often combined with liposuction to aid in the formation of an hourglass figure. Usually, the belly button will need to reset on the abdomen and tucked down to improve the abdominal groove we see in younger women.
Abdominoplasty and breast surgery is often combined in mommy makeover cases because both the breasts and belly succumb to irreversible changes from pregnancy. Combination cases means one down time, and a lower total cost than separately spaced individual abdomen or breast cases.
While the operating room time is greater for combination cases, they are performed in accredited centers in the safest manner possible. Every woman is checked out by her physician and all applicable blood work will be examined. For women having breast surgery, pre-operative mammograms may be recommended to get baseline studies since breast surgery can change the architecture of the breast.