Mommy Makeover
The term “Mommy Makeover” is a catch-all phrase often used to describe a wide range of procedures designed to correct the undesirable physical changes that are sometimes associated with pregnancy. Most commonly, these procedures are directed at the two areas of the body that are the most negatively impacted by pregnancy: the breasts and the abdomen.
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While some of these physical changes are reversible with a return to pre-pregnancy body weight, many are not. It is important for women (and their spouses or significant others) to realize that some of these problems are mechanical in nature, and will not improve even with proper diet and exercise. Women should never feel guilty that they “just aren’t working hard enough” to return to their pre-pregnancy forms when more than diet and exercise alone may actually be necessary.
Physical Changes & Pregnancy
Breast enlargement during pregnancy begins to become noticeable in the first trimester (typically at 6 to 8 weeks), with continued growth occurring throughout the second and third trimesters. As the glandular elements of the breast enlarge (in preparation for breastfeeding) the overlying skin envelope of the breast and the underlying retaining (Cooper’s) ligaments can become stretched out. If these structures become stretched beyond their elastic limits, stretch marks and sagging (ptosis) may ensue.
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Similarly, as the uterus and fetus enlarge, so does the entire abdomen. This can result in 1) overstretching of the skin, 2) the deposition of hormonal (diet-resistant) subcutaneous fat, and 3) the separation of the paired rectus muscles. Again, if elastic limits are exceeded, stretch marks and laxity will ensue. Furthermore, the separation of the rectus muscles (which is equivalent to a full-length abdominal hernia) can produce a generalized abdominal bulge that will never be corrected by any form of dieting or exercise.
Different women will respond in different ways to these changes. Women with high elastin contents in their skin and connective tissues (by luck of the genetic draw) will see the tissues rebound and return to their original states without even a single stretch mark remaining. Others less fortunate will have their tissues stretched beyond their elastic limits. The result will be small tears in the skin itself (“stretch marks”) and permanent laxity of the skin and supporting ligaments (ptosis). Again, these are mechanical problems for which a mechanical solution (surgery) may ultimately be necessary.
Breast Procedures
Women with smaller breasts prior to pregnancy will oftentimes like the added volume that the physiological breast enlargement associated with pregnancy gives them. For this group of women, a simple breast augmentation (with saline or silicone implants) will be all that is needed to re-establish the look that they temporarily had while being pregnant.
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Conversely, women with moderate sized breasts may often experience greater degrees of breast enlargement that may exceed the elastic limits of the breast tissues, resulting in eventual sagging of the breasts. This group of women may want to consider a breast lift, or VERTICAL MASTOPEXY (see Figure 1a), with or without a corresponding implant, depending upon loss or gain of breast tissue volume.
Finally, women with larger breasts to begin with can often experience even further enlargement of the breasts during pregnancy that leaves them with larger and more ptotic breasts than they had to begin with. In this group, a VERTICAL BREAST REDUCTION would be the ideal choice for establishing a more comfortable breast size and shape.
Abdominal Procedures
Again, women with high elastin contents in their skin and connective tissues can often rebound back to their pre-pregnancy forms with simply an excess of lower abdominal fat remaining. In this instance, Liposuction alone may be all that is needed to remove the diet-resistant fat that is not going away, even with adequate diet and exercise.
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Women who experience accumulation of lower abdominal fat along with some lower abdominal skin laxity may be good candidates for a MINI ABDOMINOPLASTY. In this instance, the excess skin and the excess fat can be directly excised to re-establish a more pleasing abdominal contour.
Finally, women who experience a generalized stretching of the abdominal skin, significant accumulation of hormonal fat, and separation (diastasis) of the paired rectus muscles more than likely will require a FULL ABDOMINOPLASTY (see Figure 1b) to fully restore the aesthetics of the abdomen. Excess skin and fat will be directly removed, and the separated rectus muscles will be tightened back together in the midline. The end result will be a tightening and flattening of the abdomen as a whole.
Mommy Makeover Timing
How long does a woman have to wait after having a baby before scheduling the surgical procedures above? In general, the body must be given adequate time to rebound back to as close to ‘normal’ as possible. As much of the added “baby weight” that has been gained during pregnancy should be lost by way of a sound plan of diet and exercise. In addition, hormonal levels should be allowed to re-equilibrate and stabilize over time. A reasonable rule of thumb for most women would be to allow for at least six months for the body to reach a new state of physiological equilibrium and stability.
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Is it wise to consider surgical corrections if another pregnancy is a possibility in the future?
It depends. If a woman wants to re-establish the breast fullness that she had during pregnancy, it would not be unreasonable to proceed with AUGMENTATION, even if another pregnancy is a possibility. If residual skin laxity is also involved, a MASTOPEXY might also be considered (with the understanding that further tightening may be required after future pregnancies). Finally, if undesired fullness and laxity are involved, a BREAST REDUCTION might be considered to alleviate symptoms such as neck and back pain, again with the understanding that a secondary procedure may be required after subsequent pregnancies.
Similarly, if a woman is left with only an excess of diet-resistant abdominal fat, Liposuction alone may be considered to restore the abdominal contour, even if future pregnancies are a possibility. Similarly, a MINI-ABDOMINOPLASTY may be considered as a temporizing solution for excess skin and fat that does not respond fully to diet and exercise. On the other hand, it would be unwise to proceed with a FULL ABDOMINOPLASTY procedure if another pregnancy remains a possibility. The remaining abdominal skin (which will already have been re-stretched by the surgical procedure itself) may be drastically over-stretched. Furthermore, the mechanical repair of the rectus diastasis could be completely disrupted and undone, requiring more complicated secondary repair. As such, this particular procedure is best delayed until no further pregnancies are being planned.
Optimizing Results
Diet and Exercise can do things that surgery cannot. Conversely, surgery can often do things that diet and exercise cannot. It is important to realize that the two often work synergistically with one another, not exclusively of one another. Eat better and smarter. Fit exercise into your busy life as much as possible. Lose as much of the extra ‘baby’ weight as possible and work on making yourself healthier in the long run. And when the stretched out skin and stubborn lower abdominal fat is not getting any better in the mirror, do not get frustrated. Do not feel guilty that you are “just not working hard enough”. Realize that sometimes you just need a little extra help. And that is what we are here for.
Surgery & Recovery
Mommy makeovers are routinely performed under general anesthetic within the comfort and convenience of our on-site state-accredited operating room suite. Your recovery from a Mommy Makeover will depend on the technique Dr. Lober uses. During this recovery period, you will experience swelling, discomfort and bruising which is all very normal and part of the healing process, lasting for up to 4 - 6 weeks. You should be able to return to work with minimal activity within 1 - 2 weeks however a full recovery, where you're feeling like yourself may take up to two months. You always should follow Dr. Lober's post-surgical instructions, wearing compression garments and taking medications as needed.
Tummy Tuck
An abdominoplasty is a cosmetic procedure that is designed to improve the overall appearance of the abdomen. It accomplishes this by removing excess skin and fat. It can also further tighten and flatten the abdomen by repairing any separation of the paired rectus muscles that may have occurred due to pregnancy or weight gain. Pregnancy can produce a profound stretching of the abdominal skin. If the skin becomes stretched beyond its elastic limits, micro-tears in the skin (“stretch marks”) can be produced. The resulting skin redundancies and stretch marks cannot be corrected by diet and exercise alone.
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Pregnancy can produce a profound stretching of the abdominal skin. If the skin becomes stretched beyond its elastic limits, micro-tears in the skin (“stretch marks”) can be produced. The resulting skin redundancies and stretch marks cannot be corrected by diet and exercise alone.
Pregnancy (and weight gain) can also stimulate the production of additional fat cells in the lower abdominal tissues in women. These fat cells are hormonal and diet -resistant, and once added to the fat cell population, they are added for good. They can be shrunk in size by way of diet and exercise, but they will never go away on their own.
Finally, the intra-abdominal protrusion can stretch the paired rectus muscles apart, leading to a weakness of the entire vertical midline of the abdominal wall. This can give the appearance of residual bulging of the abdomen long after the pregnancy has been completed. This weakness in the abdominal wall (the equivalent of a hernia) can only be corrected by mechanically plicating the muscles back together.
Many women feel guilty that they cannot correct these problem areas just by working hard enough via diet and exercise. It is important for them (and their husbands) to realize that these are mechanical problems that can only be corrected with the mechanical solutions of direct excision and repair. Simply put, surgery can do things that diet and exercise alone cannot.
But this is not to say that surgery is a substitute for adequate diet and exercise. It is not. Surgery can indeed do things that diet and exercise cannot do. But diet and exercise can also do things that surgery cannot. When both are used in conjunction with one another, a woman can once again re-establish (and often improve) the abdominal contour that she once had prior to pregnancy or weight gain.
Best Candidates
Women who have returned to a healthy body weight after pregnancy but still have stretched-out skin, residual diet-resistant fat, and separation of the abdominal muscles are good candidates for a tummy tuck. Similarly, women that have successfully lost excess body weight through the combined effects of diet optimization (gradually eating fewer calories and gradually eating better quality calories) and exercise, but still have redundancies of excess skin and diet-resistant fat are also excellent candidates for the procedure.
Tummy Tuck Timing
Those women who are firmly committed to the healthy reduction of body weight (and Body Fat) should actually focus on diet modification and a sound exercise program first. In the ideal world, the procedure can then be performed at any time after a healthy body weight has been achieved.
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In the real world, many women never get to this final healthy body weight on their own. They are diligently doing the hard work of eating better and exercising harder, and they are seeing the numbers fall on the scales. But every time they look in the mirror, they do not see how much more muscular definition they have in their arms and their legs and how better (and healthier) they are looking overall. The only thing that they see is the same redundant skin and fat, and the same lower bulge of the abdomen that they had to begin with. Frustration ensues as weight loss begins to plateau, and hope begins to be lost.
For these patients, Dr. Lober feels that the Abdominoplasty procedure be considered at any time after the patient has reached roughly 50% of their overall weight loss goal. In this way, the procedure itself can then be used as a psychological “carrot on a stick” to help these patients get themselves past the plateau phase of weight loss and ultimately on to their final body weight goal.
The Abdominoplasty procedure can produce dramatic improvements in a patient’s visual appearance, but it absolutely must be utilized in conjunction with diet modification and exercise in order to reach the ultimate goal of achieving not only healthier total body weight, but also a healthier overall body composition as well.
Types of Tummy Tucks
Different women can experience different combinations of mechanical deformities (excess skin; excess diet-resistant fat; muscle separation) due to pregnancy or weight gain. In general, there are two different types of Tummy TucK. Both procedures commonly utilize additional liposuction of the abdomen and hips (typically considered as being part of the procedure) to achieve the best final abdominal contour.
Surgery & Recovery
The Tummy Tuck Procedure is performed under general anesthesia in our private Surgery Center. The procedure generally takes anywhere from one and a half to two and a half hours to perform. Absorbable sutures are utilized, and drains (usually two) are required for this procedure. These drains are typically removed within 7 to 10 days. Patients are encouraged to resume light activities the day after surgery. Some patients are able to drive within 3 to 5 days, but most will not feel comfortable driving until 7 to 10 days. Moderate exercise can be resumed by 14 days.
Dietary Preperation
Post Surgery Diet
Eating the right foods after recovering from tummy tuck surgery is essential to speed up the healing process. Though there’s no hard and fast tummy tuck recovery diet that every patient must follow, there are a few foods that are more beneficial than the rest.
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Immediately after tummy tuck surgery, patients may want to take things slowly. Typically, most patients will want to eat something light. Low-sodium soups are ideal and won’t leave them feeling uncomfortably full.
If light soups aren’t enough, Saltines and Belvita biscuits can help create feelings of fullness. Still, patients must take care to eat them sparingly with sips of water to aid digestion.
The following day, patients can start to eat a heavier tummy tuck recovery diet with denser foods.
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The key to a successful tummy tuck diet lies in eating high-protein meals every day during recovery. This gives the body the nutrients it needs to recover faster and more thoroughly.
Foods like chicken breast, fish, turkey, protein powders, and vegetarian proteins like tofu are all great options to incorporate into a tummy tuck diet plan.
Immediately after surgery, it is normal for patients not to feel terribly hungry or have enough energy to cook a full meal. In this case, they should consume protein shakes until they feel better. Patients are encouraged to choose options that are low in sugar and high in nutrients to help their body heal.
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While recovering from surgery, patients must prioritize drinking plenty of fluids. It is important to stay hydrated at all times.
Sipping on water throughout the day, even if thirst is not present, can help prevent dehydration. If water is too bland, Powerade and ginger ale are great alternatives. However, one must be mindful of the amount of sugar these products contain.
As the patient progresses through recovery, she should avoid drinking alcohol and should consume caffeine in moderation.
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Tummy tuck recovery diets are most successful when they prioritize eating clean, unprocessed, and healthy foods. Junk foods and dishes with processed ingredients should be avoided as they have minimal nutritional value and won’t help with recovery.
If possible, the patient should also try to avoid dishes that are high in fat and simple carbs like white rice, bread, pasta, and potatoes. These can increase inflammation and contribute to discomfort during recovery.
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Though a healthy tummy tuck recovery diet will provide plenty of nutrients, vitamins, and minerals, the patient may still want to take some supplements to further boost the body’s natural healing abilities. Vitamin C and omega-3 supplements can help reduce inflammation and speed up healing. Taking probiotics can make it easier for the body to digest foods immediately after surgery.
If a patent is not sure which supplements will help her best, she should speak to her plastic surgery team before the surgery. They’ll be able to provide recommendations.
Full Body Lift
Body Lift Surgery is designed to treat sagging buttocks, hips, abdomen, and thighs. A variety of different incision patterns can be used to remove excess skin and tighten the affected areas of the lower body. Most commonly, these procedures are utilized in patients who have experienced dramatic weight losses and have inordinate amounts of residual redundant tissues.
Surgery & Recovery
All Body Lift Surgeries are performed under General Anesthesia, either in the privacy of our own Surgery Center or in a Hospital Outpatient Facility. The surgery itself can range from two to four hours long. Drains are almost always used, and the sutures are generally all absorbable.
Patients tend to experience more extended recovery times with this procedure than others due to the extent and the locations of the incisions. It is very important to avoid early overactivity, which can stimulate the production of drainage fluids and the possibility of “seroma” formation. Driving should be refrained from for at least a full week. Light activities can usually be resumed by 10-14 days.
Liposuction
Liposuction is the ‘gold standard’ for removing excess, unwanted subcutaneous body fat from specific areas of the body with minimally invasive scars. It can provide for true ‘spot reduction’ of excess fat in a well-controlled, sculptural fashion. All other methods of reducing excess fat (freezing; thermally heating; etc.) simply provide for less controlled and less reliable removal of excess subcutaneous fat.
Best Candidates
All fat cells are not created equally. The superficial subcutaneous fat layer that encompasses a majority of the body (much like a diver’s wetsuit) contains fat cells that are physiological in nature. These cells enlarge in volume when caloric intake exceeds caloric demand, and shrink in size when caloric demands outstrip caloric availability.
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In contrast, there are specific deposits of Body Fat deep to the superficial layer that contain fat cells that are primarily structural in nature. These fat cells are genetically designed to protect specific areas of the body. As such, they vary little in size with fluctuations in the energy balance of the body (these cells have fewer cell surface receptors and respond differently to physiological changes).
Liposuction surgery is ideally suited for those patients who have reached a healthy body weight via diet and exercise but still have ‘diet-resistant’ genetic deposits of fat that will not shrink in size. These deposits are outside of the physiological loop of the body and will remain in place until physically removed. Common patients for liposuction also include mothers who are interested in mommy make-over procedures.
Does liposuction work? Liposuction procedures are not a quick and easy solution to being overweight. Far from it. Like many other procedures in plastic surgery, the best results are ultimately obtained by combining the procedure itself with healthy changes in eating habits and increased levels of physical activity.
Liposuction Areas
It is perfectly safe to perform liposuction surgery on multiple different areas of the body in the same setting. It is not necessarily safe to perform extensive liposuction in combination with other large body contouring procedures wherein a large area of the body is being disrupted in a single procedure. Such “whole body makeovers” are often much safer to perform on patients in separate settings. Surgical liposuction procedures can be safely performed almost anywhere on the body, wherever there is excess ‘structural fat’. In women, this most commonly includes Abdomen, Hips, Thighs, and Arms.
Surgery & Recovery
All liposuction procedures are performed in our private surgery center under IV sedation only. General anesthesia is not necessary and most procedures last less than an hour. There are no stitches and no drains.
Patients will realize the best results when they wear appropriate compression garments for the first 6 to 8 weeks. Patients have very minimal downtime and most are able to drive within the next one to two days. Recovery is often described as a sense of ‘soreness’ without actual pain. Exercise can be resumed as soon as it is comfortable to do so.
Arm Lift
Unwanted fullness in the upper arms can be caused by excess subcutaneous fat, sagging and redundant skin, or the combined effects of both. These excesses can be due to either genetic influences, the aging process, or be created as the undesirable ‘side effects’ of dramatic weight losses. Brachioplasty surgery is designed to remove these excess tissues, either directly or indirectly. The ultimate goal is to achieve a smoother, tighter contour to the upper arm that will better match the proportions of the lower arm and the rest of the body.
Procedure
Ideally, excessive fullness in the upper arm can be reduced via the use of Liposuction alone. A modest number of very small (¼ inch) incisions are used to liposuction the entire circumference of the arm. Excess subcutaneous fat is removed and the upper arm is adjusted proportionally to the size of each patient.
If too much excess skin is present, it will be necessary to directly excise both skin and fat from the inner surface of the upper arm. In some instances, this will leave a short scar that can be well hidden inside the upper arm. In cases where the skin excess is significant, however, it may be necessary to extend the scar down to the level of the elbow.
Surgery & Recovery
All arm lift surgeries are performed under general anesthesia in the privacy of our own Surgery Center. The surgery itself is generally two hours long. No drains are used, and all sutures are absorbable for this procedure.
Patients can expect to return to light activity within several days, including driving. Those with “desk” jobs can return to work within 5 to 7 days. Those with physically demanding jobs (manufacturing, retail, nursing, etc.) should be able to return to work within 10 to 14 days.
Skin Cancer Surgery
Skin Cancer is by far the most common form of cancer, and its incidence is increasing worldwide. Individually, the risk of Skin Cancer increases as you age, which is likely due to the accumulated exposure of UV radiation and to the aging process itself. A history of frequent sunburns, especially when they occurred during childhood, is especially associated with a higher risk of developing Skin Cancers.
Types of Skin Cancers
It is important to note that these three different Skin Cancers can vary widely in appearance from the descriptions given above. Even experts in Skin Cancer treatment can be fooled by just the visual appearance of the skin lesion itself. A general rule of thumb of Dr. Lober’s is that if a patient goes to the trouble of making an appointment and coming in to be seen about a specific lesion that they, or a family member, have been worried about, the lesion is either going to be biopsied or removed in its entirety. The earlier these lesions are diagnosed and treated, the better the overall outcome, especially in cases of Malignant Melanoma.
Such lesions should be biopsied to rule out the possibility of malignancy. Small “punch” or “shave” biopsies may be obtained of suspicious lesions as very limited office procedures. Alternatively, if the lesion is not too large, the “biopsy” may consist of removing the lesion in its entirety. Again, this can usually be done as a minor procedure in the office under local anesthesia only.
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• Scaling and ulceration/bleeding
• Unusual growth patterns
• Failure to heal
• Firm, upraised borders with depressed center
• Irregular edges and pigment distribution
Skin Cancer Diagnosis
Surgery & Recovery
If the lesion proves to be malignant, it may be necessary to remove a larger area of surrounding tissue to adequately treat the skin cancer and help prevent future recurrence. Definitive removal is typically performed either with the help of Frozen Section Control or via Mohs Surgery. If the lesion is a Melanoma, it may also be necessary to sample lymph nodes at the time of primary excision to rule out lymphatic spread.
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After adequate excision, the resulting defect can be closed by a number of different methods. Again, if the defect is relatively small it can often be closed primarily. Larger lesions may require rearrangement of the adjacent tissues as Local Flaps to achieve full closure. Finally, some defects may require skin grafts or composite grafts to completely cover the exposed defect.
Most skin cancer surgeries are performed by Dr. Lober as minor treatment procedures in his Surgery Center using Local Anesthesia only. If the lesions are in areas that are particularly sensitive, such as the nose, the eyes, or the lips, these surgeries can be performed under IV Sedation to provide the patient with a much more comfortable overall surgical experience.
Only rarely is General Anesthesia required for the definitive excision and reconstruction of skin cancers. This is particularly true for the treatment of Melanomas, where wider margins must be removed around the primary lesion and where Lymph Nodes must be excised to rule out the regional spread of cancer. These procedures are almost always done on an outpatient basis in the hospital.
Patients are discharged home after almost all surgeries, even if done in the hospital. Specific postoperative limitations are very much dependent upon the location and the extent of the surgical procedure that is being performed.
Patients can expect to return to driving and most other activities by the following day. Intense physical exertion should be refrained from until the closure is adequately healed.