Tummy tucks: is less more?

Pregnancy and breast feeding hasten the effects of ageing on the body. It is especially after the second child that I receive requests for surgery. "I held it together after the first, but when the second one came it all fell apart," is what I commonly hear. The extra demands placed on a busy mother of a second or subsequent child make it difficult to get one's body back. Fortunately, the plastic surgeon can help.

During pregnancy it is not unusual for women to put on 15-20 kg. The hormonal effects of childbearing have diverse effects. Relaxin, for example, is a hormone that allows the birth canal to dilate to allow the passage of the newborn. Imagine the effect it has on your skin and the collagen and elastin fibres which keep your skin taut and firm. Other hormones play a role too.

The skin of your tummy is stretched very rapidly (9 months is not a long time) and then expected to shrink down after delivery. Stretch marks and baggy skin may be the thanks your bonny offspring give you. As you put on weight, you thicken the layer of fat all over your body and often individuals tend to put on weight in particular areas like the tummy or thighs. This will result in the pot belly frequently seen after pregnancy. The vertically-orientated rectus muscles on each side of your belly have horizontal tendinous insertions which are responsible for your six pack (it is there in everyone!). In pregnancy, the rectus muscles of the abdominal wall are split apart, so called rectus divarification, which results in loss of muscle tone and abdominal wall laxity as well. If you delivered by Caessarian section, your gynae will have left a scar down there. Their concern is your safety and secondarily the safety of the baby. The aesthetics of the scar may not be their top priority, although many are now more cosmetically aware.

Your breasts are likely to have enlarged during the course of your pregnancy. A lot of women (and their husbands) are delighted when they slowly increase from that A or small B to a full B and maybe even a C cup. For some women, who are big to start with, the increase in size is very unwelcome. An increase in size results in an increase in weight and subsequent droop, or ptosis, as plastic surgeons like to call it. If you breast feed, you may maintain or even further increase the size of your breasts. But sooner or later the party is over and like the your child's balloon 5 days after their party, your breasts deflate and you start to ask: "Where have they gone?" I frequently see patients with empty, drooped breasts after pregnancy and breast feeding. There is no doubt, however, that for your child, breast is best.

I see a lot of patients, frequently after their second or subsequent pregnancy, who come to me seeking their old body back. I wish I could make them all happy. Clearly there is some responsibility on the part of the patient. A healthy diet and a sensible exercise plan are really the cornerstones of achieving that aim. In this regard, a dietician and a personal trainer can be a real help. Unfortunately there is no magic pill, potion or patch that will make you lose weight. I believe that the formula is simple: energy in and energy out, i.e, watch what you eat and make sure you exercise.

There are a number of options for the tummy. I am keen on mini tummy tucks in the right patient. A mini tummy tuck is often well suited to the woman who needs removal of a small overhang of tissue over her Caessar scar, some tightening of the lower tummy muscles below the belly button and some lipo. Women who have completed their families and who have a bigger problem may be better off with a full tummy tuck.

For the breasts, I most frequently do a breast augmentation procedure. Not only does placing an implant restore volume, but it provides a little lift too and it is the breast operation which leaves the least scarring. Often women who have had a couple of kids and who now have empty breasts have emptiness in the upper pole which is well remedied by conventional breast augmentation using a standard round implant. Breast augmentation is also fully discussed in a previous newsletter and on my site.

Mastopexy is an operation done to lift the breasts. Usually the process of lifting the breasts makes them feel a little bigger. The redistribution of tissue higher up on the chest is obviously desirable, but mastopexy (or more properly, dermal mastopexy - skin breast lift) does have its price. Often the women requesting mastopexies once had good breasts which have now drooped. To elevate them one needs to make incisions and leave scars, usually a lollipop shape, on the breast. In addition, gravity will continue to act on the breasts and in time they may droop again.

For some women, pregnancy causes the breasts to enlarge. Combined with unwanted weight gain, these large breasts can be problematic and cause neck, shoulder and back pain, rashes underneath the breasts, discomfort and even headaches. It is not uncommon for women to request breast reduction after pregnancy and breast feeding.

Following child rearing many women develop fatty deposits which are difficult to shift with diet and exercise. As long as their weight is normal for their height, they may be suitable for liposuction. Also discussed in a previous newsletter, sometimes the love handles, saddlebags and other bits simply will not shift. Liposuction, fortunately, is now one of the safest procedures (if performed properly) and can be repeated to serially remove fat - in my opinion safer than doing one massive lipo.

Other, less usual requests following child birth and breast feeding are correction of inverted nipples, nipple reduction, areolar reduction and correction of the Caessar scar.

There is no doubt that pregnancy and breast feeding place an enorous toll on a woman's body. Plastic surgery can provide some help in restoring what has changed. Exercise and diet also play a key role.

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