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Saint Thomas Health Medical Mondays: Mommy Makeover & Cosmetic Surgery -- July 22, 2013 -- Dr. Mary Gingrass & Dr. Melinda Haws

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Saint Thomas Health Medical Mondays
Monday, July 22, 2013
TOPIC: Mommy Makeover & Cosmetic Surgery

Mary Gingrass, MD: plastic surgeon
Melinda Haws, MD: plastic surgeon

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Mommy Makeover: A Plastic Surgery Trend

A growing number of women are undergoing mommy makeovers -- plastic surgery procedures that restore their post-pregnancy bodies.

When Lisa Brock, of Lebanon, Pa., decided to get a breast lift and augmentation one year after delivering her fourth child, she had no idea she was embarking on phase one of her "mommy makeover."  She just knew she wanted her old breasts back.

"Before children, I was a full C cup," she says.  "After breastfeeding all four kids, I was less than an A.  I was a board.  I just hung.  Even my mother said she'd never seen anyone that needed surgery more than me."

Even though Brock was only 29 at the time, she had the surgery and was thrilled with the result.  Now, the licensed practical nurse, who is 31, has just gone back for more.  This time, she had a tummy tuck.

"God forbid I should have lifted up my shirt and let someone see that bump," she says, referring to her sagging stomach, which eight months of steady dieting and daily workouts had done nothing to cure.  "It's not fat.  It's just loose skin that I have no control over."

Brock is part of a growing number of women undergoing mommy makeovers -- multiple plastic surgery procedures that restore, or improve, their post-pregnancy bodies.

While it's difficult to come by exact numbers for mommy makeovers because it's a marketing term, not a surgical one, Douglas Mackenzie, MD, a board-certified plastic surgeon in Santa Barbara, Calif., says that mothers are by far his largest demographic. He attributes the trend to our obsession with youth as well as the public's acceptance of plastic surgery.  Even the numerous television makeover shows, he says, are merely an indication of a boom that began awhile back.

"Unlike our parents generation, [these mothers] want to stay young and feel young, and preserve the body they've had," he says.  "The music they listen to, the restaurants they go to, the clothes they wear, all have a lot to do with it.  It's a new generation."

According to the American Society of Plastic Surgery (ASPS), 36% of the 9.9 million surgical and minimally-invasive cosmetic procedures performed in 2006 were on patients between the ages of 30 and 39; 29% of them were aged 20 to 29.

Breast augmentations increased 55% from 2000 to 2006, going from 212,500 procedures to 329,326.  Breast lifts -- another favorite among the mommy makeover crowd -- went up 96% during the past six years, with the total number of procedures going from 52,836 to 103,788.  Tummy tucks jumped a whopping 4,384% and buttock lifts increased 174%. 

"Breast augmentation was very popular during the 1970s and 1980s," she says. "They called it 'restoration of the breasts due to postpartum changes,' and it was done very, very quietly, and insurance paid for it.  From 1991 to 2003, there was a hiatus because women were scared that implants were unsafe, so they wanted to see the science.  After that, it became safe again, which is why we're seeing [the upswing]."

Jennifer Malone, 32, is one of those moms. Three months ago, the Jefferson, Ga., real estate agent opted for the postpartum plastic surgery trifecta: tummy tuck; breast lift plus augmentation; and liposuction on her legs, arms, stomach, and lower back. 

Later this year, Malone, who has three school-age children, also plans to take advantage of the free liposuction "touch-ups" included in the package.

"I can't wait," she says.  "And if the boobs start resagging, she'll relift them for free, too."

Costs and Complications

Those changes didn't come without pain, however.  While serious complications and death are infrequent, pain from the procedures can be severe, especially in the first several days after surgery.

Still, Malone says her recovery period was surprisingly easy, and her scars are rapidly disappearing.  Brock was also amazed at how quickly she bounced back -- although the first three days after her surgeries were both very painful.

Cost is another factor.  Malone financed the $14,000 cost of her mommy makeover with a gift from her father.  Brock paid for both of her surgeries with a credit card.

In 2006, Americans spent $11.5 billion on cosmetic procedures.  The national average surgeon's fee for breast augmentation was $3,600.  Tummy tucks averaged $5,063 and liposuction, $2,750.  Add anesthesia, hospital fees, and other incidentals, and the price tags rise significantly. 

A Different Choice

Not everyone is rushing to the operating table, however.

Casas estimates that the breasts of one-third of the mothers she's seen during her 18 years of practice return to normal after pregnancy -- if their weight does.  Another third suffer from stretched skin and less breast tissue.  The final third, which often includes those who do not lose the baby weight, have larger breasts after their deliveries.

She also recommends that patients try and tighten up their abdominal area first through diet and exercise, which in many cases allow them to bypass a tummy tuck.

Even cosmetic genitoplasty, which often includes modification of the labia minora or labia majora, has come into vogue.

Laurie Casas, MD, a board-certified plastic surgeon and the co-author of a textbook on cosmetic breast augmentation, insists that while plastic surgery patients may be getting younger on the whole, postpartum plastic surgery for mothers isn't new.

She also recommends that patients try and tighten up their abdominal area first through diet and exercise, which in many cases allow them to bypass a tummy tuck.

"Some women bounce back like nothing ever happened," Mackenzie says. "Some women's bodies are ravaged after pregnancy."

Casas is also concerned about her patients' overall health.  She prefers the term "restoration" to "mommy makeovers," and unlike many plastic surgeons, refuses to operate on anyone who isn't willing to practice self-discipline.

"Liposuction, yes, but I won't perform invasive plastic surgery on someone who is 30 pounds overweight," she says.  "I require all my patients to exercise and have good nutrition.  If you want me to artificially suture your [abdominal] muscles, that's fine.  But you can blow it out again by overeating or overdoing it.  So why not just work on it before the surgery?"

Casas offers these recommendations to women considering mommy makeovers, so that they'll attain the best possible outcome -- and maintain those results.  She suggests that postpartumplastic surgery patients:

  1. Achieve their desired target weight first.
  2. Make sure they are exercising at least 30 minutes per day: a minimum of 15 minutes of interval training and 15 minutes of resistance training, alternating different body parts, on different days of the week.
  3. Practice superb nutrition. 
  4. Keep alcohol consumption at less than 2-3 drinks per week.
  5. Quit smoking.
  6. Establish a no-fail support system for the full recovery period dictated by your surgeon.

This last requirement, she says, is critical. 

"The biggest problem with mommies is that they don't have someone to take care of their babies and their kids, and they don't take care of themselves," Casas explains.  "I won't operate on a mother with kids under 5 unless she has someone to take care of her children for at least two weeks.  It just doesn't make sense if you're going to be lifting and driving and doing the laundry and cleaning house.  You're just going to ruin your results."

So far, neither Brock nor Malone is complaining about their results -- or doing anything to jeopardize them.

"Oh, my gosh!" Brock says.  "My self-esteem is amazing!  I can look in the mirror again without cringing."

Malone says the experience has given her a renewed sense of self. 

"I just love being a girl and a woman again," she gushes.  "I'm feeling more and more like an individual.  My old personality is creeping back."

Casas reminds those who have had mommy makeovers that nothing is permanent.  In addition to the inevitable aging process, some procedures need ongoing surgeries.

"Breast implants, like all medical devices, require maintenance," she says.


The Most Common Cosmetic Surgeries

Cosmetic Surgery Sees Increase, While Botox and Other Minimally Invasive Procedures Fall


Close to 10 million cosmetic procedures were performed in the United States in 2012, and Americans spent nearly $10 billion on cosmetic procedures last year.

These are some of the key findings in the new statistics from the American Society for Aesthetic Plastic Surgery (ASAPS).

Cosmetic surgical procedures increased almost 1% since 2010, while minimally invasive procedures decreased almost 2% in the same time period.

This is the 15th year the ASAPS has tracked plastic surgery. Since 1997, cosmetic procedures have increased 197% for men and women combined -- and there have been some changes over the years.

"Surgery seems to be slowly coming back," says ASAPS President Jeffrey M. Kenkel, MD. He is a professor and vice chairman of the department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas.

Noninvasive procedures such as injectables do have a role, but individuals are looking for more durable results, says Kenkel.

One of the reasons that the numbers are creeping up is that people need to stay in the work force longer, which means that they must compete with their younger counterparts for the same jobs, he says.

Liposuction topped the list of most popular plastic surgeries in 2011, and injections of botulinum toxin type A (including Botox and Dysport) ranked as the top nonsurgical procedures, the new statistics show.

Top Surgical Procedures

According to the new statistics, the top five surgical procedures in 2011 were:

Fully two-thirds of women opting for breast augmentation with implants chose silicone-filled breast implants in 2011. Kenkel says this shows that women and plastic surgeons are becoming more comfortable with the safety of these implants.

Due to safety concerns, there was a 14-year ban on the use of silicone breast implants. This ban was lifted in 2006. In a further nod confirming the safety of these implants, the FDA recently approved a new silicone-gel breast implant from Sientra, making it the third company to market these implants in the U.S.

Top Nonsurgical Procedures

The top five minimally invasive procedures were:

  • Botulinum toxin type A
  • Hyaluronic acid-based fillers (for treatment of wrinkles)
  • Laser hair removal
  • Microdermabrasion
  • Intense pulsed light (IPL) treatments (for treatment of skin redness and uneven skin tone)

Women had almost 9 million cosmetic procedures in 2012, and men had over 1 million. The number of cosmetic procedures for men increased over 121% from 1997, which was the year that ASAPS first started tracking these statistics.

The new statistics were based on questionnaires sent to dermatologists, otolaryngologists, and plastic surgeons. More than 1,100 doctors returned the questionnaires. The final sample included responses from 420 plastic surgeons, 384 dermatologists, and 211 otolaryngologists.


Plastic Surgery After Weight Loss

Many people who have lost 100 pounds or more are overjoyed at their success -- but may be dismayed that their body does not have better shape and tone.

With plastic surgery after weight loss, you can remove loose, heavy folds of skin -- and improve the shape and tone of tissue in the arms, thighs, breasts, buttocks, face, and abdomen.

For years, prescription retinoids (face medications like Retin-A, Renova, and Tazorac that contain the vitamin A derivative) have been assumed to be the best antiaging products. Indeed, decades of clinical research show that they speed cell turnover to smooth wrinkles, fade sunspots, and build collagen. But now there are claims that they can also thin the skin and cause chronic inflammation (peeling, lobster-red faces), actually leading to premature aging. The issue is dividing...A variety of cosmetic surgeries can help you gain a trimmer, firmer shape: Body contouring (body lift surgery), tummy tuck (abdominoplasty), buttock augmentation, breast lifts, and arm lifts.

Body Contouring (Body Lift)

Body lift surgery is one of the most common procedures to improve the body's appearance after weight loss surgery. It's also long-lasting, if you keep your weight stable.

Here's what happens: With one incision along the abdomen, the surgeon can remove excess, sagging skin -- lifting and tightening the buttocks, abdomen, waist, hips, thighs, and arms in one procedure. Liposuction is often used to remove fat and improve the body contour. Buttock augmentation may be done --because buttocks often flatten with extreme weight loss.

Body lift surgery can dramatically change your appearance, and the results are permanent, except for a little natural firmness that's lost with age.

But body lifts are not without some risk. For example, there will be some scarring. Some people continue to have problems with loose skin. Some people need a follow-up cosmetic procedure.

The higher your BMI [body mass index], the more likely there will be complications. Possible complications of body lifts include bleeding, infection, tissue death, abnormal scars, and formation of a seroma -- a mass or lump that results from fluid buildup in an organ or tissue.

Your surgeon can talk to you about the potential problems. But for most people, the result is a smoother, more normal body shape.

Tummy Tuck (Abdominoplasty)

A "tummy tuck" is often performed as part of body lift surgery -- to remove fat and skin, and in some cases help tighten your abdominal muscles, creating a smoother, firmer abdomen. A tummy tuck can help flatten your stomach when diet, exercise, and weight loss have not done enough. Don't confuse a tummy tuck with liposuction -- although you may need liposuction as part of your tummy tuck.

A full tummy tuck involves a large incision from hipbone to hipbone, around the naval. Your surgeon can then manipulate the skin, tissues, and muscle --and repair weakened abdominal muscles. Your belly button will be lifted to a more pleasing spot. In some cases, a second incision is necessary to remove excess skin in the upper abdomen. While there will be scars, they will fade somewhat.

The result is a firmer, flatter abdomen that better matches your trimmer figure.

Breast Lift (Mastopexy)

If your breasts are sagging, a breast lift can help lift, firm, and reshape them. In a breast lift, excess skin and tissue are removed, and the nipple is repositioned higher on the chest. Some people also need a breast implant to improve the breast's shape.

At times there is need for a touch-up procedure. If there are slight differences between the breasts after breast lift surgery, the surgeon may need to reposition the nipple.

Should You Have Plastic Surgery After Weight Loss?

You are likely a good candidate for plastic surgery after weight loss if:

  • Your weight has stabilized
  • You don't have medical conditions that impair healing or increase risk of surgery
  • You're a nonsmoker
  • You have a positive outlook and realistic goals for the procedure
  • You are committed to proper nutrition, fitness, and an overall healthy lifestyle

If you're a woman planning a family, it's best to wait until after you've had your babies before having plastic surgery after weight loss.

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