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Motherhood is a blessing, but it can also wreak havoc on the body. Pregnancy is nothing short of a traumatic process that can permanently alter the structure, shape and often times, function of the female body. Additionally, the psychological effects of seeing a body ravaged by the process of childbirth can leave a woman feeling unattractive and self-conscious, particularly during sexual relations. Because these changes are structural, no amount of exercise or diet will alter these physical deformations; only a surgical intervention can reshape and reform the post-partum body.
During pregnancy, the enlarging breasts stretch the skin as well as the interior ligaments. Once the hormones return to pre-pregnancy levels, the skin and the ligaments remain lengthened and as the breasts return to normal size, the result is smaller breasts that sag.
Changes to the trunk are even more dramatic and predictable in women that do not have adequate pelvic/abdominal volume for late term fetal development. These women are typically shorter in height, possess narrow hips, or are “short-waisted”. The result is outward growth of the fetus with overstretching of the skin and the abdominal wall. Following delivery this results in an expansion and bulging of the lower abdominal wall. This also occurs in the upper abdominal area, but to a lesser extent, due to the support of the lower rib cage.
Females of child-bearing age, as well as those who are beyond that stage, having a growing need and interest in post-partum procedures; especially the tummy tuck
and breast lift/augmentation. In 2005, more than 20% of the surgical procedures performed were to lift or augment the breast. If you include abdominoplasty this number rises to 30%. The majority of these patients fell in the 30 to 55 age group. This follows the growing trend of young adults who are exercising, eating well and want to look as good as they feel. The sense of empowerment and self-confidence that a healthy appearance creates in the individual is undeniable.
Rejuvenation of the lower abdomen should include the following: Inconspicuous incisions within the bikini line; reduction of stretch marks; flattening of the abdominal contour; reduction in the waistline measurements; tightening of the skin about the hips, thighs and groin areas; elevation and normal position of sagging pubic skin; improvement of body posture; relief of back pain if related to body posture and lower abdominal sagging.
Rejuvenation of the breast involves the following: Converting the flattened breast to a more rounded and globular structure; elevating the nipple-areolar complex; down-sizing of the widened areola; elevating and projecting the breast tissue; maintaining or improving nipple sensitivity.
A thorough history and physical examination will address important topics including health issues and family health history. Careful measurements of the chest, waist and hips as well as height and weight are taken. Patients are also measured and fitted for a postoperative surgical girdle because a girdle manages postoperative swelling.
Discussions with the patient include suction lipectomy (traditional and ultrasonic), commonly referred to as liposuction. Assessment of flank and back fat is extremely important. Contouring of these areas can provide dramatic three dimensional changes to the patient’s entire lower body and a significant change in clothing size. It is worthwhile having this discussion, if only to advise the patient that a tummy tuck alone will improve appearances and make existing clothes fit better, but will not significantly decrease size.
Prior to surgery patients are advised to stay well-hydrated and a simple bowel cleanout with magnesium citrate is performed the day prior to surgery to avoid issues of constipation.
Post-partum breast changes can be described as a loss of volume and a stretching out of skin. Options include removal of skin to accommodate existing volume or volume expansion to accommodate the existing stretched skin, or a combination of these procedures. Mastopexy is lifting and tightening of the breast tissue and augmentation is the expanding of the breast with a saline or silicone filled implant. Implants require placement under as much tissue as possible to obtain a natural look and feel.
Post-operative motion exercises and physical therapy techniques are used to improve circulation and reduce swelling around the pectoral muscle. In situations
where an augmentation is performed alone, this reduction in swelling decreases pain and allows most patients to be managed on Ibuprofen alone.
Abdominoplasty has many variations in its technique. In considering how to approach a particular patient, attention is directed to the pattern of skin looseness. During surgery, stretched skin is removed and the tummy is tightened. Liposuction of the flanks with abdominoplasty is routinely performed to obtain typically dramatic results. The abdominal wall repair takes into consideration the degree of abdominal wall stretch and the quality of the tissue. Lastly, the patient needs to understand the long-term nature of recovery. It took nine months to create the body changes and that is approximately the time for optimal recovery and results to be visible. A good support system of family and friends will help patients stay positive during the long recovery period.
Before and 6mon after tummy tuck and flank liposuction; the scar is designed to hide beneath high leg cut swimsuits.
The traumatic effects of pregnancy can be remedied; all that is required is a committed patient, an organized plan, an experienced plastic surgeon and a positive attitude!