A few mommy makeover patients will confess to some embarrassing feelings of guilt—as if they shouldn't be prioritizing themselves. Others will worry about the message it may send to their young children, particularly daughters old enough to notice any change in their mother's body. These are concerns that Dr. Teitelbaum frequently hears from his patients and he considers counseling patients about these issues to be nearly as important as the surgery itself.
With pregnancy, the skin over the stomach and the skin over the breast both stretch, and often they do not go back to where they used to be. If the breast is loose and volume is lost, then the patient may choose to have a breast lift along with a breast augmentation. Frequently these patients also have loose, excess, or stretch-marked skin on their abdomen.
If the problem is just fat and the skin is excellent, then liposuction is the ideal procedure. However, if the skin is redundant or damaged, then some type of a tummy tuck may have to be done.
The effect of babies on both areas of the body is similar: the underlying tissues enlarge—the breasts by engorgement by hormones and milk, and the abdomen by baby. Unfortunately, the skin does not always remember the way it was before children, and skin on both the tummy and breast may not snap back to where it was before. It's remarkable that some very young women can have a small baby and end up with a very loose stomach while some older moms with a large baby may have little laxity of their stomachs. These differences are largely a matter of genetics and may in fact have little to do with how much weight is gained during pregnancy.
If the breast skin drops south, then a lift may need to be considered. However, if the breast just collapses or deflates, then a breast augmentation alone is the ideal procedure. In general, A and B cup breasts before babies are more likely to collapse and just need an implant while breasts that were larger C and D cups tend to drop and need a lift. Nevertheless, each patient is different and needs to be assessed in an individual way.
Breast augmentation is the most common breast procedure for moms needing a mommy makeover. If a woman's breasts are droopy but are still about the size she wants them to be, then she needs a lift. If her breasts are too big for her, then she needs a reduction.
But most frequently, breasts will deflate or collapse. Patients will describe them with terms such as "empty sacks" or "pancaked." Others will say they just got a bit smaller or somehow don't seem as full and perky. Some will mention that augmentation was something they always thought about but chose to delay until they were done having children. One patient aptly described her goal as merely needing "a refill."
The concepts behind this type of tummy tuck are abstract and in this paper Dr. Teitelbaum explains them to other surgeons.
Some women are lucky enough to maintain good skin on their hips and stomach and can get the result they want just with liposuction. But, far more often, there is loose or hanging skin, stretch marks, a separation of muscles of their abdominal wall, a protruding belly button, or some puckering along a Caesarean section scar.
During a mommy makeover, a tummy tuck can improve three things:
1. First, it can remove and tighten loose or excess skin and generally can remove stretch marks up to about the height of the belly button. Higher stretch marks are not removed, but look better with the skin stretched tighter. Many women work out, use expensive creams, try various laser treatments, but surgery is the only thing that can actually remove skin.
2. Second, extra fat can also be removed, making a woman thinner and in fact more attractively shaped and better balanced as well. When there is an excess fat layer elsewhere in the abdomen or in the hips, then Dr. Teitelbaum performs simultaneous liposuction to sculpt his patients. Taking an artistic approach to the abdomen means considering the beauty and proportion of the entire trunk.
3. Finally, the two muscles that go up and down the abdomen from the ribs all the way down to the pubic area often separate with pregnancy. The medical term for this is "rectus diastasis," and a tummy tuck can fix this condition. Do a sit up with your fingers pressing gently in the middle just above your belly button: if you can feel a gap, then you have a diastasis. As the day goes on and you eat and get too tired to hold in your stomach, that gap widens. Some women will say that they even feel pregnant by the end of the day.
Dr. Teitelbaum practices in a community in which many mothers carry twins and triplets as a result of fertility medicine. While some mothers with twins have stomachs no worse than those of mothers with singlets, there is frequently greater laxity of skin and weakness of the abdominal muscles.
There is no single abdominoplasty technique that is best for all women. Some have more separation or muscle weakness; some carried low and some high; some just in the center; and others all over. This creates many different patterns and Dr. Teitelbaum customizes what he does to the abdomens in mommy makeover patients to what they need the most. Some may need just a small incision that is no wider than a c-section scar. Others need an incision that goes almost to their backs. Some need their muscles tightened while others do not. Dr. Teitelbaum is eminently experienced in tailoring and executing an operation that best suits each patient.
Liposuction has a very important role in mommy makeovers: For some women it needs to be done in combination with a tummy tuck in order to thin the upper abdomen. For others, the flatter abdomen can make the hips or outer thighs look disproportionate, so liposuction is done in these areas to balance out the smaller stomach. Not infrequently, women lose their waist with pregnancy. Liposuction can re-sculpt this area to narrow the waist and restore—or even improve upon—how a woman looked before her pregnancy.
Some women are lucky enough not to need a tummy tuck but nevertheless have excess fat in their stomach, hip, or outer thighs. This may have been an issue before children, but it can also get worse or develop with weight gain during pregnancy. Dropping this extra fat is often very hard, and so liposuction can be a great help to these patients.
Dr. Teitelbaum continues to use all of the latest and best methods of liposuction including ultrasonic liposuction, syringe liposuction, and power-assisted liposuction. But rather than focusing on a specific technology, he emphasizes both in his lectures and in his practice that the best liposuction results come from the artistry of a surgeon rather than the technology itself.
It is also possible to have a hernia. A diastasis is just a separation, but women with a hernia in that area—called a "ventral hernia"—will usually feel a bulge in addition to the separation. Often, women will develop a hernia in their belly button with pregnancy, converting what used to be an "innie" into an "outie." This is very common and can be fixed with the tummy tuck.
Many mothers want to have a "mini tummy tuck," and this is occasionally possible. But in most cases, a mother's the loose skin is not just towards the center. If a woman sits upright in a chair and looks down, she will see how wide her loose skin extends and she will be able to predict to some extent how wide her scars would need to be to get the best shape. Some women only have loose muscles but maintain tight skin. These women are ideally suited for what is called an "endoscopic tummy tuck" or "endoscopic abdominoplasty," in which only a small, easily concealable incision is made.
Dr. Teitelbaum understands that "mommy makeover" patients are not just patients—they are mommies. Every step he takes emphasizes health, safety, and the absolute priority of the mother timing the surgery in a way that is most suitable for her and her family.
A big decision mommy makeover patients and their plastic surgeon have to make is how much surgery should be done at once. Every patient is inclined to do everything during one surgery, but recent data suggests that for some patients separating the surgery into separate stages is safer. Dr. Teitelbaum keeps up to date with the most current thinking and will help you develop the surgical plan that is best for you.
While the health of every patient is important, for mommy makeover patients, safety considerations are logically an even greater priority. Not only do moms need to get back to their children quickly, but mommy makeover patients need a sense of security before surgery that they are choosing to do something that will be safe for them and their family.
Insurance does not cover mommy makeover surgery, but sometimes an umbilical hernia can develop with pregnancy and this may be covered by insurance. But this is only a small portion of the total cost of a mommy makeover. Tummy tucks and breast procedures are not covered by insurance. The cost for your mommy makeover will be covered in detail at consultation, and financing is available through CareCredit.
In the photo gallery, the before and after mommy makeover photos shown are of patients who did something to both their breasts and their bodies. To learn more about the options for the breast and the abdomen, look through the specific sections for those procedures.
Dr. Teitelbaum was rigorously trained in surgery at Beth Israel Hospital/Harvard Medical School. His approach to mommy makeover patients is enthusiastic, artistic, and creative—an approach built on the foundation of his training as a scientist and physician. Since 1993, Dr. Teitelbaum has done various sorts of mommy makeovers for hundreds of women, restoring their bodies to as close to their pre-pregnancy condition as modern medicine allows—and oftentimes making their bodies better than they were even before their pregnancies.