There is no question that kids are wonderful, but also no question that they can take a lot out of you, in more ways than one! Pregnancy, and especially repeated pregnancies, stretch and distort the breasts and abdomen. Fortunately, there is something you can do about it: a combination of surgeries we call the "Post-Baby Tune-Up".
Years before the term "Mommy Makeover" became popular, Dr. Nachbar had been doing combined procedures to help women whose bodies had been ravaged by pregnancy, especially multiple pregnancies. Because he was doing so many of these procedures, he coined the term "Post-Baby Tune-Up". Later, on February 21, 2003, he applied for a trademark on that name, and on February 3, 2004, the US Patent and Trademark Office granted him that trademark.
In April 2004, Dr. Nachbar attended the annual ASAPS meeting in Vancouver and happened to ride the bus from the airport with Patricia Anstett, a reporter for the Detroit Free Press, and explained the Post Baby Tune-Up® procedure to her. As reported by Word Spy, her subsequent article about the Post-Baby Tune-Up® procedure in the Detroit Free Press on July 9, 2004 is the earliest citation of the term "Mommy Makeover".
Ms. Anstett was awarded the 2005 ASAPS Journalistic Achievement Award in the Newspaper category for her article, which was picked up by papers around the world. And now you know how the Mommy Makeover was born, right here in Scottsdale, Arizona!
The effects of pregnancy on the abdomen are fairly obvious. Although the uterus is usually about the size of an orange, during pregnancy, the baby grows inside the uterus, stretching the uterus and ultimately the abdominal wall. As the baby grows, the uterus presses on the inside of the muscle wall of the abdomen. At the front of the abdomen, the two vertically oriented "Rectus" muscles (the "six-pack" muscles) get pulled apart, and actually separate as the fascia elongates. Once that has happened, nothing other than surgery can bring them back together. Exercise can't do it, since there is no muscle in the midline for you to exercise.
In addition to the muscle, the skin gets stretched as the baby grows. This is especially notable in the center of the abdomen, near the belly button. Stretch marks may develop. Once the baby is delivered, the skin collapses, and may leave loose, hanging skin. Because the underlying muscle has also been stretched, a bulge may be apparent in the lower abdomen, especially when you stand up.
The effects on the breasts are no less dramatic. Due to hormonal changes brought on by pregnancy, the breasts start to grow, especially as the baby is getting ready to be born. Following delivery, breast feeding causes the breasts to repeatedly stretch. Once breast-feeding is complete, the breasts typically decrease in size, often to a size smaller than they were before the pregnancy. Again, stretch marks and loose skin result, and the breast tissue loses its substance and starts to hang.
While even a single pregnancy has these effects, I have seen repeated pregnancy doing the most damage. Often, a woman will tell me that she had little trouble after the first and second child, but the third one caused a tremendous amount of abdominal stretching and breast tissue loss. Extra collections of fat, which might have been present but much less obvious, become apparent. The frequent combination of these problems: breast tissue loss and drooping, abdominal stretching of muscle and skin, and local collections of fat, led us to develop the Post-Baby Tune-Up. Modern surgical technology, often in a Hospital-based facility, allows us to safely combine these procedures.
For the abdomen, treatment generally requires either an Abdominoplasty or a Mini-Abdominoplasty. The Abdominoplasty allows us to tighten the abdominal muscle all the way from the ribcage to the pubic bone, and allows us to tighten the skin of both the upper and lower abdomen. The Mini-Abdominoplasty is similar, but only tightens the muscle and skin of the lower abdomen, from the belly button down. Either procedure results in a scar that runs along the lower abdomen, but the scar can be hidden within the swimsuit line. Other procedures can be designed to shorten or minimize the scar, but if there is excess or loose skin, tightening the skin will require a scar.
If there is excess fat of the abdomen, we may be able to address that as well. Liposuction is the surgical removal of fat through tiny openings, resulting in tiny scars. If we are doing a Mini-Abdominoplasty, we can use liposuction of the upper abdomen to reduce the fat there. If we are doing a full Abdominoplasty, additional liposuction at the same time can be problematic, but we can remove some fat from the abdomen using other techniques, and liposuction can be used at a second procedure to remove remaining excess fat.
For the breast, there are several options, depending on the loss of tissue, the amount of drooping, and the desire to replace the lost fullness and volume of the breast. Mild droopiness of the breast can be improved with breast implants, without a breast lift. If the nipple is not too low, the skin and breast tissue is not too soft, and the woman is willing to accept some increase in breast size, this can be a good choice. It is very important to understand the amount of improvement that is realistic in this circumstance, but many patients have been very happy with this technique. It generally takes several months following surgery to see the final result with breast augmentation, and that is particularly true if there is some drooping before surgery. To see the results of breast augmentation in patients with somewhat droopy breasts without breast lift, see our "Droopy Breast Augmentation" page.
Of course, breast lift, or "Mastopexy", can be done without placement of breast implants. Breast lift brings the nipples back up, generally along with tightening of the skin under the breasts. However, breast lift alone will not fix the loss of fullness of the breast, especially the upper breast, which occurs following pregnancy. Therefore, when breast lift is done following pregnancy, it is most often combined with breast implants, although relatively small implants may be used if desired. This allows recovery of the fullness of the upper portion of the breast. Alternatively, removal of droopy breast tissue combined with breast augmentation can allow the breast to achieve an improved shape without being enlarged (or even combined with reduction in breast size). The breast implant is placed under the muscle (Pectoralis Major), which helps hold the implants up.
Along with abdominal and breast surgery, the Post-Baby Tune-Up often includes liposuction, to reduce the localized collections of fat that can develop. Liposuction is the permanent removal of localized fat. This can be done at the same time to maximize the improvement from surgery. Although liposuction of the abdomen is not generally done at the same time as full Abdominoplasty, liposuction of other areas, such as the hips, thighs, and knees, can be done. Either standard or ultrasonic liposuction can be used, as appropriate. Other procedures we often add are lifting of the thighs or the arms.
Patients often ask about whether these procedures can be combined, and the answer is: it depends. Anesthesia has improved significantly in the past several years, improving both safety and comfort. Better monitoring devices and better medications have combined to make longer procedures safer. Blankets that blow hot air over the patient during surgery help keep her warm. As the various procedures are done on the various parts of the body, the blankets are moved so that the patient remains warm. State-of-the-art facilities, generally hospital-based, are used for these more complex procedures, and allow the patient to stay overnight following surgery. For an active, healthy woman, quite lengthy procedures are quite reasonable, and allow her to achieve all or most of her goals with a single recovery period. Smaller procedures, such as abdominal liposuction, can be added later with very little additional recovery.
Children add many dimensions to your life. Fortunately, the Post-Baby Tune-Up can help you undo some of the physical changes pregnancy can cause. To find out more about what Plastic Surgery can do for you, call Dr. Nachbar at 480-289-5300.
This information is provided for general information only. Please consult with your local Plastic Surgeon for specific information about your own situation. I recommend that you see a Plastic Surgeon certified by the American Board of Plastic Surgery. In the United States and Canada, call 800-635-0635 or 888-4PLASTIC for the names of board-certified Plastic Surgeons in your area.