What is a “Mommy Makeover”?
I am glad you asked that question. A Mommy Makeover is when we get the chance to not only do a tummy tuck but also to do breast implants at the same time. Often patients—Moms who come in–have had a lot of body changes after having their kids. With this in mind, they want to look like what they did before having kids. Most often, the trauma of child birth affects both the breasts and the abdomen.
In a Mommy Makeover, we focus on first fixing the breasts. In many cases, the breasts have involuted and have dropped or are sagging. To help this, we focus on lifting the breasts either with a simple breast lift or with a breast lift combined with implants to fill the hollowed out breast tissues. The second focus is of course the abdomen. In most women, the childbirth has stretched the tissues a great deal. We focus on not only removing and contouring the tissues of the abdomen but also on fixing the underlying midline trauma and supporting the muscles. In this way, the abdomen is actually in a better structural shape that it was before the kids.
Tell me about the new silicone / “gummy bear” breast implants…Are they safe?
Silicone implants or at the least the “gummy bear” implants have been available in the United States since 2006. In 2006, the Food and Drug Administration (FDA) after a 14-year moratorium, and after studying thousands of patients and surgeries, decided to again allow for the implantation of silicone based implants. Most importantly, the concern about rupture and/or extrusion of silicone was noted to be false. Lastly, the thought that the silicone gel would simply seep out was noted to be false. The FDA data found that there was no relationship between silicone implants and soft tissue diseases like systemic lupus or breast cancer. Both of the concerns that during the previous decade had prompted tens of thousands of females to get their implants removed, were noted to be invalid.
After all of that, the simple answer is YES. The new generation of implants from both Allergan and Mentor are as safe as possible and extremely sturdy. They also feel almost like regular breast tissue and so are often advocated for use in patients undergoing breast surgery, in cosmetic augmentation or in breast reconstruction.
What are the possible complications?
Like with any surgery, there are risks and complications. In a Mommy Makeover, the risks are of course slightly higher. This is because you are combining two procedures. The risks of problems with breast augmentation are bleeding, infection, scarring, extrusion, and capsular contraction. The risks of bleeding and infection are handled with meticulous intaroperperaive care of any bleeding sites and with the use of antibiotics, respectively. Extrusion is only seen when a patient does not heed or listen to our instructions and tries to do too much right after surgery. By pushing it too much, the patient tends to weaken the incisions and in rare cases, the incisions split open and the implants are exposed. If such a rare event does happen, we immediately see the patient, optimize the concern and reoperate and close off the weakened area. Ideally, with a little bit of foresight, no one should be stressing the incisions too early and should not be at risk for extrusion. Capsular contraction is a well-known complication that affects all patients that undergo breast implantation. It is thought that it is related to a microfilm type of infection/reaction on top of the implant. This is not “rejection of the implant by the body” as some convey. It simply is a sub-clinical infection that over times causes the shell around a breast implant to harden and become problematic. To combat this, we use ample antibiotics before and after surgery. We also have patients actively engage in post-operative massage to minimize the hardening seen with capsular contraction.
As for the abdominal aspect of the surgery, the risks are slightly different. These are risks of bleeding, infection, seroma, thickened scars, dehiscence, and contour irregularity. Again, bleeding and infection are well handled right after surgery with meticulous care. The prevalence of seroma is handled with the use of drains. Even though the fad now is not to have drains, drains act as a safety measure to minimize the chance of seroma formation. We routinely place two drains in and follow their outputs diligently after surgery. As soon as they are ready and we think the chance for a seroma formation has been minimized, we remove the drains, one at a time. Also, we advocate the use of compression garments. With the use of compression garments, the tissues are pressed together after surgery and are given their best chances for healing. As can be imagined, the contouring compression garment further pushes the fluid out of the tissues and in this way minimizes the chances for seroma formation. Last but not least, the presence of contour irregularity. This tends to be a product of lack of planning. Let me explain here—Everyone’s body is different or unique. With careful foresight, the abdominal area can be marked to make sure that the tissues can be mobilized downwards and the excess skin can be resected safely. Only when this early planning is not judiciously done do you tend to see contour irregularities. Another possible cause for contour asymmetries is again the formation of a seroma. When a patient has not worn their garments as instructed or has been too diligent during their post-operative recovery, there is a chance that fluid can build under the tissue flaps. This adds to the chances for contour irregularity after an abdominoplasty.
Who usually gets the procedure?
Most commonly a Mommy Makeover is seen with women who have had their kids and are now ready for the next stage of their lives. They have optimized themselves as much as possible. Once they have done their best, our job is then to help them along with resection of extra skin and contouring of the additional tissues to make sure everything fits and looks like it did before the kids.
What if I get pregnant in the future?
If the patient gets pregnant after surgery, of course, the body again will go through its natural changes. Unfortunately, it is hard to predict how this will impact the overall body contour. In some patients, the trauma is less than others. If so, there is a real possibility that the changes will not be that bad. In other cases, however, the changes could be dramatic and can undue the surgical corrections that have been done in a surgery. For this reason, we thoroughly vet patients to make sure that they are done having children. If they are not, it is recommended that they wait until they are sure.
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with a Mommy Makeover is due to the bruising and the swelling involved. In regards to the breasts, the muscle will be sore and bruised. This of course will pass. To help this along, we give patients prescriptions for pain and anti-spams medications. As for the abdominal aspect of the operation, the pain tends to dissipate after about two-three weeks. Most of the pain has been described to me as having a severe cramp. Again, to handle this, we offer patient prescriptions for pain medications and for anti-spasm medications. Many of the patients compare a tummy tuck to a C-section and note that the C-section is actually worse. After surgery, most patients complain more about the soreness and the aching sensation than actual pain.
Please also note that now as a matter of common practice, we infiltrate the abdominal wall and the incisions will long term anesthetic local medications to give patients/Mommies, a good deal of immediate post operative pain relief.
How long do I need to take off from work?
Great question. Most often I suggest to patients that they consider taking about 2 to 3 weeks from work. Let me elaborate. Once you’ve had Mommy Makeover, the areas involved becomes swollen and in many cases becomes extremely bruised. This area then slowly goes through healing. We have patients wear contour pressure garments to help with the swelling. This also helps with the postoperative pain as the swelling is controlled. We have patients start walking on post-operative day #1. They are usually walking comfortably by day#3-5. Most patients note that they are comfortable walking regularly by day#7. Additional time is taken off to help patients heal from all the bruising. However, in some cases the patients are comfortable to return to their work or activities by week#2. We advise against patients going back to their workout routine until week#6-8. The logic here is to prevent patients from doing too much so as to cause additional swelling. If and when additional swelling develops, the tissues and the body parts are more apt to become more asymmetric in contour. If the patient waits until week#6-8, the chance of having contour asymmetry is much less because the underlying tissues have had time to settle and the spaces where fluid can collect have closed off.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and
their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in Los Angeles and in New York. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local Oklahoma City plastic surgeon.
Does insurance pay for this?
Unfortunately, no. Insurance does not pay for any cosmetic procedures. But we do offer other options such as Care Credit. Please ask us to go through financing options with you. We would be glad to help.