Mommy makeover usually refers to procedures that combine breast reshaping and body contouring. A mommy makeover is not a procedure in and of itself. Rather, it is a term that is used when plastic surgeons combine: breast augmentation, breast lift, tummy tuck, liposuction, and perhaps other plastic surgery procedures to return the female’s body to its pre-pregnancy state.
The reasons for this procedure differs depending on who you ask that wants to go through with the procedures. Society places a premium on appearance and youthfulness and pregnancy may alter a woman’s body. That’s why a makeover is often desired after children. Top-rated mommy makeover surgeon, Dr. Tim 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 and the surgeries involved in a makeover can make a remarkable difference.
Some may feel that dieting and exercise alone can return a woman’s body to it’s pre-preganancy state. While this may be true in some cases, some mothers may be left with unwanted changes, such as loss of upper breast fullness or form, loose abdominal skin and stretch marks. While diet and exercise is great and can improve some of the look, nothing will match the stunning results a complete makeover can provide. When plastic surgeons combine breast augmentation, breast lift, liposuction, and a tummy tuck, these procedures will completely change the body’s form, giving you a look you desired perhaps even before you were pregnant.
When undergoing breast augmentation, breasts are reshaped by either making them larger or lifting them. On other occasions, we may reduce the breast size through a breast reduction (although this is not common).
Body contouring procedures such as liposuction and a tummy tuck 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. If women are healthy, procedures that address these concerns can safely be done simultaneously, allowing for just one recovery period and a complete transformation.
Breast Procedures in Mommy Makeovers
Pregnancy can induce changes to the appearance of the chest and belly area. Often, these changes are permanent and improve little after giving birth. The breasts engorge with milk during the process of lactation during pregnancy. As the breasts enlarge, the tissues stretch. Depending on the 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 post-pregnancy may look flat and deflated. They have lost their youthful, perky appearance. The abdomen also follows similar rules which will be discussed later. 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. That is why the timing of the procedures is critical.
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 you will “survive” a pregnancy without a permanently 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 after having a child is a breast augmentation. Often, women will think that their breasts are now “saggy” or droopy. However, most often, changes after pregnancy are simply volume and skin area mismatches. Simply adding more volume frequently restores their look to a perky, pre-pregnancy state. In less frequent cases, an implant alone cannot achieve the pre-pregnancy look. In these cases, a lift may be required to raise the nipple and remove extra skin.
The options for breast shape improvement for a makeover include:
Breast lift (mastopexy)
In some cases, plastic surgeons make combine enlarging the breast and a breast lift. Post-pregnancy, 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. Both have their own set of advantages and disadvantages (which are discussed below).
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 they shrink, the skin often doesn’t follow completely. However, before proceeding a breast augmentation, it is wise to wait 3-6 months following lactation to ensure that the breast has stopped contracting. Prematurely operating will result in sub-optimal shape and may even contribute to infection or capsular contracture.
Choosing an Implant
Silicone implants tend 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). This would lead many women to believe that silicone should always be the superior choice. However, this shortsighted thinking will occasionally result in sub-optimal results. Silicone, because it is softer and behaves more like breast tissue under the influence of gravity, may not “lift” as much as an overfilled saline implant. In women with reasonably full breasts, saline is often the best choice to restore perkiness if there are no plans to remove skin with a mastopexy. However, in women with more mild deflation, thinner tissues, and smaller breasts, silicone may be the most appropriate choice.
Saline implants are often over-filled to create a more solid, and rounder implant than its silicone cousins. The disadvantages to this are probably obvious. They often will feel firmer than non-augmented breasts or silicone-augmented breasts. However, if the breasts are large enough, the tissue can pad the implant. The advantage to an overfilled saline implant is that it can fill the upper pole of the region better than silicone. Much of the deflation that occurs after pregnancy occurs in the upper portion of the breast. Larger, over-filled implants may be the perfect choice in this scenario.
While it is true that most breast augmentations are performed in a submuscular fashion (under the muscle), women after pregnancy can benefit from a subglandular (over the muscle) approach. Deflated breasts can develop “pseudoptosis”, which is a fancy word for a type of droopiness where the nipple stays high in relation to the sagging you may be witnessing. True ptosis, or saggy breasts, is a condition where both the nipple and breast have descended below the fold. In pseudoptosis, a subglandular approach can elevate the breast tissue more than a submuscular approach. In women with ample tissue in this area, this may be their preferred approach. Or, a dual-plane approach may be performed. This is a method where the implant is placed under the muscle but the tissue is still elevated off the muscle. The bottom line is that there is no cookbook recipe for a mommy makeover. Every woman must be evaluated properly to find the perfect fit.
Breast lift (Mastopexy)
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 mastopexy is the appropriate operation. There are several different types of breast lifts. In short, the more lift required to form a perky appearance, 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 the surgery is to trade shape for scars. 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). Sometimes even the addition of a small breast implant can obviate the need more large incisions. This should be addressed during your consultation.
Combining Breast Augmentation with a Breast Lift
A breast lift with enlargement using implants is a popular procedure among women who have had children. Women miss the fullness and perkiness. The combination breast augmentation-mastopexy is often the perfect choice to satisfy their desire to return to the beautiful apperance of their youth.
There are generally 4 types of breast lift procedures:
- Lift with implant alone
- Lift using peri-areola approach (Benelli lift)
- Vertical breast lift, or “lollipop lift”
- Inverted T, “anchor”, or Wise-pattern breast lift
As mentioned above, an 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. In order to achieve the best results for women with significant deflation and drooping, 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 fold.
The peri-areola approach The Benelli or peri-areola approach describes the method 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 to the 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 between shape and 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 to the vertical lift approach. The addition of the vertical scar attached to the areola scar will result in a more powerful lift and improved shape.
Your Breast Lift Options to Consider
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 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 small horizontal scar 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 lift is reserved for very droopy breasts that require a substantial lift. In most of the 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 procedure done, the new, beautiful shape 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.
Lipo and/or Tummy Tuck
The greater the amount of sagging skin, the longer the incision will need to be 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 be repositioned 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 are succumb to irreversible changes from pregnancy. Combination cases means one down time, and a lower total cost than separate procedures.
While the operating room time is greater for combination cases, they are performed in accredited centers in the safest manner possible. Every woman undergoes a thorough examination and all applicable blood work will be reviewed. For women having breast surgery, pre-operative mammograms may be recommended to get baseline studies since surgery can change the architecture of the breast.
Schedule a Complimentary Mommy Makeover Consultation at our Los Angeles Office
If you are ready to restore your body and meet with one of Los Angeles’ top plastic surgeons, call our practice today. Dr. Neavin is qualified to help you meet all of your aesthetic goals and has performed hundreds of mommy makeover surgeries. To schedule your consultation today, contact Artisan of Beauty at 310‑858‑8811 or text 323‑975‑1287.