Mummy Makeover: Your Complete Guide to Post Pregnancy Surgery

Mummy Makeover is a new term. Its use has suddenly evolved over the last few years but importantly, this is not an accurate nor defined medical or surgical term. “Mummy Makeover” is, in fact, merely a marketing term used to categorize a series of non-cosmetic and cosmetic procedures whose purpose is to attempt to restore a woman’s body to its pre-pregnancy state.

Pregnancy is a very natural process, as are normal vaginal deliveries. However, there are defined hormonal changes that occur from the time of conception and throughout the pregnancy, including changes before and during delivery all the way to the completion of lactation and breast feeding.

pregnant stomach

It is only some months (3-6) after lactation has ceased that the normal, pre-pregnancy hormone profile returns to normal.

So, the changes to your body that result from this very natural process are significant and unfortunately are permanent. Your pre-baby body is gone forever!

In discussing the concept of the “mummy makeover,” 2 situations will arise: firstly, what I call the desired outcome: a post-pregnancy weight (body fat content) that is close to or equals the pre-pregnancy weight (body fat content).

Secondly, what I will call the undesired outcome: a situation that has resulted in a large change in the post-pregnancy weight (body fat content), where the woman has noticeably increased her body fat content during her pregnancy (eating for 2!).

The reason for this separation into 2 groups of women is important. The body changes are different and, therefore, the surgery to improve and enhance the common areas of concern will also be different.

Women with significant weight gain will usually need more complex operations but even more importantly, will usually require more operations on more body areas.

I will first discuss the different areas of the body that women commonly wish to improve/enhance, next the specific operations that can be performed and finally, the options for the women who have gained significant weight during their pregnancy.

The 2 areas that women most frequently request to improve/repair are the abdomen and breasts. For more information on this, check out our article on breast changes with pregnancy.

Areas To Improve After Pregnancy

THE ABDOMEN

As your baby grows, your uterus enlarges, causing your abdomen to change. With the hormone changes that occur from the time of conception to the preparation for delivery and breast feeding, oestrogen causes a degree of softening and laxity of the body’s tissues. This mainly impacts muscles, ligaments and tendons but also affects the skin.

As the baby grows and the uterus expands, outward pressure starts to be exerted in the muscle layer of the abdomen. This results in a stretch of the abdominal muscles and, because of the effects of the hormone changes, the main ligament that joins the right and left sides of the muscles in the middle of the abdomen will also start to stretch.

It is also important to point out that the belly button (umbilicus) is situated within this abdominal ligament and is a natural scar. However, with the stretch of this central ligament, the belly button also stretches with the evolving pregnancy.

The result of this is the separation of the abdominal muscles but also, a number of women will develop an umbilical hernia. This manifests a protruding belly button (an “outy” instead of an “inny”).

The skin overstretches and the outcome is loose, lax skin with stretch-marks that initially are red-pink but fade with time to become silvery-white.

If your baby is born by Caesarean section, then the scar together with the aforementioned skin changes results in the “overhang” of loose skin over the c/s scar. Twins or multiple pregnancies and excessive weight gain make this problem worse.

THE BREASTS

Regardless of their size, non-pregnant breasts consist mainly of fat with a much smaller breast gland component. With the hormonal changes, the breast gland component dramatically expands at the expense of the breast fat.

These are the early changes that ultimately result in milk production (lactation). The end result of these hormonal changes is very enlarged, uncomfortable, heavy breasts. After delivery and after breast feeding, the hormonal profile returns to your pre-pregnancy state.

As a result, breast gland components return to their pre-pregnancy state. Unfortunately, the breast fat component does not return as glands subside. Because the breast skin has expanded to accommodate the size increase of your breasts and your breasts’ loss of fat and volume, the skin expansion results in droop. Additionally, the hormonal changes have an impact on your skin overall.

Pregnancy, childbirth and breast feeding will result in your breasts becoming “empty” with significant droop. The pigmented skin around the nipple called the areola enlarges as well. These changes worsen the longer you breast feed, and the more children you have.

The next issue is the timeframe between delivering your baby and having surgery.  Ideally, you need to wait until your baby is 6 months old. This ensures that the hormone profile will have returned to the pre-pregnancy state.

If you would like to learn more about post-pregnancy breasts, read our article on breast augmentation, cosmetic surgery and pregnancy.

VAGINAL REJUVENATION

The next discussion point is much more personal and intimate. It is common during a vaginal delivery for a procedure called an episiotomy to be performed. This is a cut into the skin and tissues towards the back of the vaginal opening on the right side to prevent an uncontrolled vaginal tear from occurring.

Performing an episiotomy cut is precise and prevents unwanted tearing. In an uncontrolled situation, the tear can even extend backwards into the anal canal resulting in the so called 4th degree tear.

The episiotomy cut often involves the inner labia towards the back. Childbirth and multiple deliveries can lead to changes in the inner labia that result in an unfavorable situation.  These changes are more noticeable with the modern tendency for women to reduce pubic hair by shaving, waxing, hair reduction creams and IPL hair removal.

Vaginal rejuvenation and vaginoplasty are becoming increasingly sought after. The specific options will be discussed in relation to the operations that together comprise the mummy makeover.

All areas that women express interest in improving through the mummy makeover are affected by weight gain. Now, requests to reduce the body fat content are included because the changes are no longer simply just a matter of “repair” and tightening of loose skin, laxity and muscle separation.

Mummy makeovers typically include a combination of the following procedures:

  1. Tummy Tuck (abdominoplasty)
  2. Liposuction
  3. C/S scar revision
  4. Mons pubis lift
  5. Breast Augmentation
  6. Breast lift
  7. Breast reduction
  8. Labiaplasty
  9. Labial rejuvenation
  10. Vaginal Canal rejuvenation.

Most women will request a tummy tuck (or liposculpture) with one of the breast operations.

Cosmetic Procedures

surgery operating room

BREAST SURGERIES

1. Breast Lift vs Breast Augmentation

After childrearing, many women will come in for a consultation requesting a breast lift because they are unhappy with the droop and “emptiness” that has resulted.

However, women also state that they want “something done” but will not accept the scarring that results from a lift: scarring around the areolar skin (pigmented skin around the nipple) and the vertical scar from the areolar skin downwards into the crease underneath the breast.

At the consultation, I perform a series of measurements of the breasts, as well as the breast position on the chest wall. In addition, I assess the breast position in terms of certain landmarks that I assess and demonstrate at this consultation.

Here, it often becomes apparent that a breast lift surgery may in fact, NOT be necessary. In these cases, I offer and recommend a breast augmentation. The issue to be determined next is the size and shape of the implant that will give the best result possible for the individual woman in question.

If breast skin is loose and the breast base is wide, then, the implant will need to be “big” in order to fill the breast “skin envelope.” This can only be assessed at the consultation but may be assessed via a limited series of photographs.

The modern operation is to perform a breast lift together with implants. This results in a better shape especially at the so called “upper pole” of the breast: the part of the breast that is flat and has lost the most volume.

There are many options for this procedure. Unfortunately, this operation does not always result in a long term solution. Breast droop is a natural phenomenon with time/age/gravity as well as weight gain and loss. Further pregnancies will adversely affect the breasts also. Droop is not preventable.

Some women are fortunate in that the breast supporting structures and ligaments delay droop while with other less fortunate women, droop occurs early and easily. This applies to both the natural state as well as after a lift. It is estimated that droop after a lift procedure can occur as early as 3 years after the surgery with the lesser “donut” lift or 5 or 7 years after the “classic” breast lift.

2. Breast Lift vs Breast Reduction

The boundaries between a breast lift and breast reduction are becoming increasingly blurred. It is no longer true that a breast lift (mastopexy) is the operation of choice for an up-lifted, “perky” breast. Now days, a breast reduction will also result in small (or smaller) and perkier breasts.

A breast reduction is a much more durable operation, often lasting a far longer time before droop sets in again—often in excess of 10 years! It is possible to perform this operation with implants as well. In this case, implants are more for shape than size.

Ultimately, a breast reduction may be considered the “perfect lift”. This procedure can be performed with the removal of minimal breast gland tissue or a large amount of breast tissue, depending on the individual woman’s situation and what result she desires.

The incision (and therefore scarring pattern) is the same with a classic mastopexy (lift) and a breast reduction: the so called “lollipop” scar. This is a scar around the areolar (pigmented) skin and a vertical scar down the front of the breast into the crease under the breast. The ‘old fashioned “anchor scar is rarely done today.

ABDOMINAL OPERATIONS

1. Tummy Tuck Vs Liposuction

This is a far less complex scenario. There are only 2 options: namely an abdominoplasty (tummy tuck) or one form of liposuction. The crucial factor in deciding which option is best relates to the quality of the abdominal skin and the amount of excess fat present.

As discussed above, the changes with pregnancy (more so if there is also significant weight gain) result in over-stretched skin and overall abdominal laxity. If the skin is in this condition, lipo is not an option; the only option is an abdominoplasty.

There are different “grades” of this operation, both being easy and relatively quick. The mini-tummy tuck involves the removal of a small amount of loose skin very low down that does not extend anywhere near the belly button. The scar from this procedure is almost the same as a Caesarean Section scar.

The middle grade tummy tuck involves the removal of excess skin from the level of the pelvic bone to above the belly button. This version will result in a scar from hip bone to hip bone on the other side, as well as a scar around the umbilicus (belly button).

The next two tummy tuck versions will also include liposuction as part of the procedure, as a tummy tuck operation deals exclusively with the tummy “overhang” at the lowest aspect of the abdomen.

This operation is not designed to deal well with the upper abdomen. Now, this is not a problem unless there has been significant weight gain with or subsequent to a pregnancy.

If the amount of excess upper abdominal fat is significant, liposuction will be necessary for the upper abdomen to achieve a more desirable result. Also, in the situation of upper tummy excess, it almost is universal that there will be excess fat deposited over the hips (the “love handles”). Here, liposuction will also be necessary to achieve a more desirable result.

This liposuction is an integral part of the tummy tuck operation without any additional charges. However, if other areas of lipo are to be undertaken, then additional charges will apply. This third version of the tummy tuck will also involve an incision from the hip bone of one side across to the hip bone on the other side and will include a small circular incision and scar around the belly button. This version also requires liposuction to the upper abdomen and hips.

The final grade of the tummy tuck operation is major surgery. This includes all the components of the previous version – long scar from hip bone to hip bone, scar around the belly button, liposuction of the upper abdomen and hips, with the possibility of muscle tightening with or without belly button hernia repair. This is necessary due to the separation of the muscle ligaments that occur with pregnancy with or without hernia formation.

This operation takes in excess of 4 hours, always requires an overnight hospital stay (maybe even a second nigh admitted) and will result in a very significant period of downtime and convalescence.

On the other hand, if the quality of the stomach’s skin is good with no or minimal stretch marks, then a liposuction operation is the procedure of first choice. This can even be done in the case of significant abdominal fat excess, and will be evaluated at the consultation.

Standard liposuction involves a process of “infiltrating” the fat layer with saline (salt water) solution under pressure to water-log fat. A suction then removes this water-logged fat. There are now modern liposuction systems that, include either ultrasound or laser energy to liquefy and emulsify fat prior to its removal.

These new systems allow a lower suction pressure to remove unwanted fat. The delivery of the ultrasound or laser accomplishes a significant part of the process. The result is that ultrasound or laser liposuction systems are far more accurate and will deliver overall better results than standard liposuction techniques.

Dr. Goldman is one of the very few specialists who have been trained in the art of High Definition Liposuction, also known as ultrasound or laser liposculpture. There is one final difference between liposculpture and traditional liposuction. There is conclusive evidence that ultrasound and laser energy both stimulate the skin’s under-surface to make new collagen and elastin fibres.

This caused the skin to retract/contract and “shrink-wrap” down onto the newly formed fat layer. No other liposuction system has been shown to result in this degree of skin retraction.

“THE GATEWAY”

The lower-most aspect of the abdomen is called the mons pubis. It is the junction or link between the stomach and the top of the vagina. The significance of this important zone has very suddenly become an area of concern for a large number of women due to the modern practices of pubic hair “management.”

As mentioned briefly above, it may be fair to say that most women below the age of 50 will undertake one form of hair management or another. This will range from trimming all the way through to the “complete Brazilian.” Brazilian is a term that has been coined to describe the complete absence of pubic hair via a waxing technique. Nowadays, the “best” form of The Brazilian is undertaken using IPL (Intense Pulsed Light) therapy or AFT (Advanced Fluorescent Therapy), a more powerful form of IPL.

The result of hair removal trends is that the skin of the mons pubis is now far more “noticeable.” Requests for liposuction in or even lifts of this region are becoming increasingly popular. Due to the overall effects of pregnancy, especially with significant weight gain, the mons pubis and the front aspect of the vagina (area just above the clitoral hood) descend to a lower level.

A tummy tuck alone will result in a minor lift of the mons pubis but it is possible to perform specific operations to either flatten this area or to perform a lift of the mons pubis “complex.” Dr. Goldman evaluates this as part of the mummy makeover, if specifically requested.

VAGINAL REJUVENATION

Vaginal rejuvenation consists of labiaplasty, outer labia (labia majora) rejuvenation and vaginal canal lining rejuvenation. Vaginal rejuvenation is an elective part of the mummy makeover but yields substantial results.

1.      Labiaplasty

Labiaplasty is a surgery with growing popularity: it is now almost as common as breast augmentation surgery. There are a number of reasons why women request this operation. The reasons are not always cosmetic (physical appearance) and include, for example, discomfort with activities and the wearing of certain items of clothing.

A labiaplasty is designed to result in the shortening of the overall length of the inner labia so that the “outers” will mainly cover the “inners.” It is not possible to perform this operation so that the outers completely cover the inners. This is not a natural nor desirable outcome.

There are two common operations that are considered labiaplasties: the “trimming” operation (or amputation operation) and the “wedge” operation. Dr. Goldman only performs the wedge operation and explains the differences between these operations at the consultation.

The surgery is performed using traditional surgical techniques but will soon be performed via laser. Laser labiaplasty results in better and potentially faster healing and overall yields better results. The current “gold standard” operation results in scars that are almost imperceptible. The importance of performing laser labiaplasty relates directly to the next topic.

2.      Laser Vaginal Canal Rejuvenation

There is now scientific evidence that CO2 ( carbon dioxide ) laser, through a very specific system, results in the improvement of the vaginal canal lining, including significant tightening. This is so effective in achieving this that it is now being offered as a non-surgical options for women with mild prolapse and certain forms of urinary incontinence.However, the main rejuvenating aspect of this relates to the re-establishment of the glandular structures within the vaginal canal lining.

This is also now being performed after a recent vaginal delivery to prevent undesirable changes in the vaginal canal later in life.

Peri- and post-menopausal women will achieve remarkable results in terms of the vaginal canal lining: these women develop a “wasting” of this lining with falling oestrogen levels. This manifests with a condition (in its worst form) called vaginitis.

What happens is the lining layer becomes thin and weak with a resulting loss of vaginal glands. This increases the “local” trauma but much more importantly, reduces the vaginal lubricating capability, resulting in difficult and painful sex.

Femilift from Alma Lasers or The Mona Lisa Touch from Deka Lasers are the only two systems that are able to offer this level of success. This is a non-surgical treatment that is often performed in the consulting rooms it is such a minor procedure that normally, no form of anaesthetic is necessary. A course of 3-4 treatments are usually all that is required.

Dr. Goldman will soon be offering this together with labiaplasty and outer labial rejuvenation in an operating theatre under general anaesthetic:

Labiaplasty + Outer labial filler injections + Femilift = Vaginal rejuvenation.

The concept of the mummy makeover has become mainstream but is yet to be accurately defined. Dr. Goldman will spend an hour or more with you at the consultation going through your issues and areas of concern. You may only need one or two of the operations but the surgical recommendations will be tailored to your specific needs and requirements.

Please contact Dr Goldman on 1300 453 307 , 08 9446 4444,  dr@robertgoldman.com.au, or reception@robertgoldman.com.au  for more information.