“Mommy Makeover” is a nonspecific term that was introduced into the public vocabulary around the year 2010 and has become a very popular expression. Mommy Makeover (MM) does not describe a specific procedure, rather, it describes an end result: cosmetic improvement of the breasts and abdomen. The reason it is best to think of MM as an end result is because each patient presents with unique physical findings and goals. Therefore each patient requires individualized treatment care based on a physical exam and personal values. Breast augmentation, breast lift, breast lift with implants, breast reduction, liposuction, and tummy tuck are all procedures that can be used to achieve MM results!
Usually, MM consists of combined procedures of breast augmentation (implants) with tummy tuck. The breast augmentation restores volume and size of the breast while improving shape and symmetry. The tummy tuck removes excess skin and fat, lower abdominal scars and stretch marks, tightens the abdominal strength layer, and sculpts the torso. Although these procedures are very effective at improving problems created by pregnancy, both have significant recoveries, and the tummy tuck leaves a long but usually unobtrusive scar.
After childbearing and breast-feeding, patients frequently complain that the breast is deflated, lacks upper pole fullness, and sags (breast ptosis). The medical term is “postpartum involution of the breast,” and simply means that the breast gland is smaller and the skin envelope stretched after childbearing. Additionally the supporting breast ligaments (Cooper’s ligaments) stretch, causing the gland to slide down to the lower pole of the breast, leaving upper pole with lack of fullness. Loss of breast projection also results.
If the nipple position is not too low, a breast augmentation alone will usually correct the ptosis and result in a very attractive breast. However, if the nipple sits below the inframammary fold (the crease that the bra underwire sits in), a breast lift (mastopexy) will also be required for optimal cosmetic result. Some patients with ample breast tissue may opt for a breast lift alone, while others may desire a breast augmentation with the breast lift.
Some women choose to have a breast lift without an implant because in general, undergoing a single procedure is less risky, more predictable, less costly, easier recovery (breast augmentation is more painful). Many women wish to avoid having a foreign material implanted that may need additional surgery. One thing to keep in mind is that a breast lift will result in a breast that appears, or is somewhat smaller, and may not completely correct the loss of upper pole fullness.
Many women are quite happy with the breast lift and opt for no additional surgery. Other women however decide at a later date to have a breast augmentation to augment size, improve shape, and improve upper pole fullness. A big advantage of delaying a breast augmentation is that some women will be very happy with the breast lift alone, and hence, can avoid an unnecessary procedure. Remember, surgery can be performed at a later date, but once performed, it cannot be “unperformed.”
The condition of the abdomen determines which procedure is most appropriate. The growing fetus, amniotic fluid, and swelling of the intra-abdominal organs causes the abdominal wall strength layer (“fascia”) to stretch. The fascia acts like an “internal girdle” and significantly contributes to the shape of the abdomen and torso. The fascia supports the core abdominal muscles, and unlike the muscles, is unaffected by exercise. As the fascia stretches more, the abdomen becomes rounded, even in patients who are very lean and have strong core muscles. The fascia is very strong, but once stretched, it is unlikely to return to its original state.
When the fascia is significantly stretched (diastasis recti), it must be surgically tightened or the abdomen will appear fuller and rounder than desired. Tummy tuck is the only procedure that tightens and shapes the fascia. The tummy tuck also removes the skin/fat apron (panniculus) in the lower abdomen along with stretch marks and unsightly scars. The pain and recovery from tummy tuck are significant, and a long scar results, but it is the most powerful procedure to achieve a finely sculpted torso.
Women with minimal or no stretching of the abdominal fascia may only require liposuction to achieve the desired cosmetic improvement. Liposuction is expected to be successful if the overlying skin has the capacity to shrink to the smaller size. A significant panniculus will require surgical removal (panniculectomy).
A MM is better thought of as an end result that may be achieved using appropriate procedures. Procedures can usually be combined during a single trip to the operating room but sometimes, multiple procedures are best staged. If you are considering a mommy makeover, have an open mind regarding procedure selection, and possibly staging the procedures in order to achieve your desired result safely. Remember that these are “elective procedures” so it is important to optimize conditions to minimize risk and optimize outcomes. Keep in mind that it is sometimes more prudent to have multiple procedures performed in more than one session.