22 Jun The Mummy Makeover
BY Dr Terrence Scamp
The term “Mummy Makeover” has fallen into such common usage that it seems to have slipped seamlessly into our language.
It has no specific definition but is basically a reference to a collection of procedures that can be performed to the breasts and torso all basically designed to reverse some of the “damage” from child-bearing. Naturally enough choosing the right items from the “menu” is one of the keys to getting an optimal result.
After pregnancy, the abdomen can show the results of skin laxity and the generation of extra skin to fit its previous expansion. In addition, the muscle wall of the abdomen can be stretched and the sheath portion of it in the midline may tear and create a defect and laxity there. The abdomen is a common place for women (and men) to lay down fat and commonly after pregnancy there is a deposit of fat in this region.
If the tissues have coped particularly well with pregnancy, then minor liposuction to an accumulation of fat may be sufficient to restore a nice contour there. This has to be done with caution. Liposuction relies on good elasticity to smooth the contour there. Pregnancies can ruin this elasticity and if elasticity is poor, then a smooth contour may not result. Instead some irregularity and rippling may be apparent.
If there is only a minor skin excess, then a limited abdominoplasty using a relatively short scar (similar to a Cesarean scar) may be possible. This can be combined with liposuction to the abdomen and even repair of the muscle sheath low down if such is required. This range of procedures is commonly referred to as a “mini-abdominoplasty” and tends to fit a fairly limited percentage of women whose skin has survived the journey particularly well.
More commonly, skin laxity is the major feature of the aftermath of pregnancy and the classical abdominoplasty is required. This comprehensive procedure repairs and tightens the muscle sheath to restore the “hourglass” shape to the abdomen. Excess skin is excised and the scar kept as low as possible along the bikini line to make it less cosmetically obvious. The length of the scar is determined by amount of skin excess. Where skin excess is remarkable such as after large babies or multiple pregnancies then a longer scar is required to dispose of all that excess skin.
Not infrequently, liposuction to the flanks can enhance the result of abdominoplasty by accentuating the tape ring of the waist line. Liposuction adds little to the recovery time of the procedure and can enhance the waist line significantly.
Women vary enormously in the effect that pregnancy has on their breasts tissues. Reduction or repositioning may be required to adjust size and correct sag or an implant may be required to fill an empty breast. There is often a combination of these problems and a procedure such as augmentation/mastopexy, combining a breast implant with a lift, may be required to overcome the sag and restore shape and size to the breast.
These days ,with a wider array of implant shape, sizes and designs available, it is more often possible to avoid a repositioning procedure in the breast with mild sag and mask this with adequate restoration of volume with a shaped implant of specific dimensions.
However, caution must be exercised as if the degree of breast ptosis is more than mild an unattractive appearance may result with the implant sitting higher on the chest wall then would suit the nipple. This tends to exaggerate the appearance of sag rather than improve it.
Breast repositioning attempts to move the breast higher up on the chest wall and make it more compact and “perky”. This is in contrast to the effect of breast augmentation which tends to expand the breast. As you can see these two procedures contradict and when performed at the same time there is a significant revision rate. In certain circumstances such as severe sag or a desire for particularly large implants, two-stage surgery may be recommended with the lift usually being performed first.
Implants of different dimensions may be chosen to overcome any initial breast asymmetry and a small amount of breast tissue may be removed from the lower aspect of the breast to get away from that “bottom heavy” look and create a perkier breast shape.
Whilst the breast surgery is commonly performed as a day patient, a formal abdomino plasty (tummy tuck) with a strong repair to the muscle wall is generally done in hospital. Special fine catheters are placed in the vicinity of the muscle wall repair and these are connected to a small pump which trickles local anesthetic into the site for one or more days after the operation. This minimizes the discomfort and hastens recovery.
Naturally enough, with pregnancy causing all of these problems to begin with, it is generally recommended that the “mummy makeover” be performed on women who have completed their child-bearing duties. Whilst there is no specific health risks to pregnancy subsequent to these operations, a lot of the good that is achieved may be undone by a further pregnancy.
So, if you think it is time for the “mummy makeover”, see a qualified plastic surgeon and get advice on a tailor made operation that will suit your specific needs.