The “mommy makeover” has been a plastic surgery mainstay for years. This popular term refers to the combination of procedures that is frequently performed after the body undergoes characteristic changes with pregnancy and breastfeeding. The abdomen and breasts are the body areas most affected by pregnancy and breastfeeding, so it makes sense that these are also the areas most commonly addressed in a mommy makeover. The classic mommy makeover, as we will see below, entails some fairly major surgery that is accompanied by significant recovery time. With the “modern mommy makeover,” we strive to deliver superb results with minimally invasive approaches that minimize discomfort and recovery time. To achieve these goals, we marry a razor-focused attention to the patient’s concerns with the most advanced techniques available, often combining non-invasive, minimally-invasive and more invasive procedures.
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The “mommy makeover” has been a plastic surgery mainstay for years. This popular term refers to the combination of procedures that is frequently performed after the body undergoes characteristic changes with pregnancy and breastfeeding. The abdomen and breasts are the body areas most affected by pregnancy and breastfeeding, so it makes sense that these are also the areas most commonly addressed in a mommy makeover. The classic mommy makeover, as we will see below, entails some fairly major surgery that is accompanied by significant recovery time. With the “modern mommy makeover,” we strive to deliver superb results with minimally invasive approaches that minimize discomfort and recovery time. To achieve these goals, we marry a razor-focused attention to the patient’s concerns with the most advanced techniques available, often combining non-invasive, minimally-invasive and more invasive procedures.
Strong communication is the foundation for the success of these procedures. Three dimensional imaging has emerged as a powerful tool not only for surgical planning but for patient communication as well. This technology allows the patient to see projected results with different procedures and express her feelings about the predicted outcomes. This exchange provides a foundation for the surgeon-patient relationship to be bestowed with unprecedented clarity. From taking breast measurements to recommending and demonstrating different implant sizes, and from simulating mastopexies to illustrating the results of abdominal contouring, 3D imaging is the first step of the modern mommy makeover in our practice.
The Classic Mommy Makeover
The classic mommy makeover is traditionally most concerned with restoring the appearance of the abdomen and the breasts. Other complementary procedures such as liposuction or intimate rejuvenation can be added when indicated.
Rejuvenating the postpartum abdomen classically follows an anatomy-based approach: extra skin is excised if present, fat accumulations are removed with direct excision or liposuction when indicated, and the rectus muscles are sutured to one another in the midline if the patient has a rectus diastasis. The abdominoplasty (tummy tuck) can be customized to include any or all of these maneuvers. Generally, a long (hip-to-hip) scar and a scar around the umbilicus are required, as well as two weeks of heavy recovery. Nevertheless, the tummy tuck remains the gold standard for abdominal rejuvenation, and is often worth the scars and recovery. The breast procedure of choice depends on the nature of the changes that occurred with pregnancy and breastfeeding. Breasts that have sagged can be lifted with a mastopexy, breasts that have lost volume can be augmented with implants and breasts that are larger than desired can be reduced. These are all invasive procedures with resulting scars. Again, in properly selected patients they remain the procedure of choice. Liposuction can be added to any of the above to further refine the resulting contour.
The Modern Mommy Makeover Approach
The modern mommy makeover is as much about mindset as it is about surgical technique. This approach to postpartum rejuvenation begins with a focused conversation with the patient to establish her goals for the procedure. Classically, discussions of this nature focused on the body parts involved and the desired change (loose abdominal skin? a tummy tuck is in order). With the advancing aesthetic technology, however, the planning phase for the mommy makeover has an added dimension: the degree of change desired. Some patients may opt for a less dramatic result, especially if this option is available at a lower cost and with a more rapid recovery. The modern mommy makeover offers this flexibility.
Abdominal Rejuvenation
Taking the abdomen, the classic centerpiece of the mommy makeover as an example, a full tummy tuck remains the gold standard for abdominal rejuvenation. This was the procedure performed nearly universally as part of a classic mommy makeover. A two-week recovery and hip-to-hip scar was the order of the day for the vast majority of women wanting to restore their abdomen to its pre-pregnancy appearance. The modern mommy makeover, however, offers options. For those with moderate abdominal skin laxity, BodyTite radiofrequency energy for skin tightening combined with VASER ultrasound (in more severe cases) can be a superb alternative if the patient will accept a significant improvement if not a completely flat abdomen in exchange for nearly invisible scars and almost no downtime. Similarly, while rectus plication during full abdominoplasty remains the only answer for a severe diastasis, in less significant cases non-invasive technologies like Emsculpt Neo (electromagnetic and radiofrequency energy) can be added to the procedure as well. Excess fat is effectively addressed with liposuction.
Breast Rejuvenation
Treatments for the breasts, another major component of the mommy makeover, have also significantly evolved. In the past, even for those with only mild ptosis (sagging), a mastopexy with significant scar burden was often required to achieve the desired change. Today, radiofrequency skin tightening, sometimes combined with fat grafting, can do the job with nearly invisible scars. Those desiring a breast augmentation are no-longer bound to having an implant-based procedure. For those who want a more natural approach or who would like to avoid scars, fat grafting can again be a viable alternative. Again, these less invasive approaches are not the right answer for everyone, but offer appealing options for properly informed patients with expectations matching the capabilities of these procedures.
Sexual Wellness Procedures
Intimate wellness procedures are also often performed as part of mommy makeovers. Labiaplasties and vaginoplasties, with their incisions, significant downtime and less-than-pleasant-recoveries, are no longer the only options in this realm. Several thermal energy-based devices can be very efficacious alternatives for both internal and external rejuvenation for the properly selected patient. Even pelvic floor rehabilitation has seen significant advances. Emsella uses electromagnetic energy to exercise the pelvic floor: one 30-minute session is equivalent to performing 11,000 Kegels. Unlike traditional approaches, this treatment can be performed noninvasively and while fully clothed. In fact, the patient need only sit in a special chair.
The modern mommy makeover, then, is about leveraging advanced technology, when appropriate, to deliver superb results with less recovery, less discomfort and at a lower cost than traditional procedures. Proper patient selection, education and assessment of expectations are critical to success with this approach. Some patients may still be best served with more traditional procedures or a combination of techniques. Thorough consultation and attentiveness to the patient’s desires is the first step in the process, and indeed the focal point of pre-procedure planning. And that is fairly modern too.
Darren Smith, M.D., FACS is a board certified plastic surgeon practicing in New York City. He is a known expert in aesthetic surgery and cosmetic injectable treatments.