After pregnancy and delivery, a woman finds herself with remarkable changes in her body. These changes include enlargement of the breasts secondary to hormonal surges and relaxation of the abdominal wall secondary to the stretching of that area from the pregnancy itself. These changes are distressing to many women, who still remember the bodies they had before they became moms! Many women come to our office seeking to regain their pre-pregnancy silhouettes. The most obvious changes occur in the breasts, which become larger and may sag; the tummy, which may develop stretch marks and/or a hanging abdominal “apron” (panniculus); and expansion of the waistline secondary to stretching of the abdominal musculature. When performed in a safe environment like our exclusive ambulatory surgical center, correction of these problems can be done with just one surgery. This way, a patient undergoes just one recovery period, and usually by two weeks later she can resume her regular activities, including driving and taking care of her child. The idea of a “safe environment” means several things.
First of all, we have a state-of-the-art operating room with all the equipment that you would find in a hospital operating room, since, like hospitals, we are regulated by the Department of Health. Second of all, prior to performing surgery, we perform all the usual and necessary preoperative tests, and, if necessary, seek consultation with the patient’s primary physician in order to authorize and clear the patient for the surgery. Once we are sure that the surgery can be safely performed, we do so, and we dedicate the entire day to the patient. Surgery usually begins with a breast lift to achieve the pre-pregnancy contour, but may also include breast reduction and/or insertion of implants to achieve more perkiness or better size. We balance the amount of tissue that is removed during any reduction with the volume that is added by the implant in order to achieve the final breast size and shape that a patient desires; this is usually a B- or C-cup. We prefer to use saline-filled implants, which we consider safer. However, if for some reason a patient prefers to go with silicone gel implants, we will do that. Once we are finished with the breast reconstruction, we focus on the abdomen. Sometimes we need to do liposculpture of the abdomen, and may also do liposculpture of the back, combining these procedures with the removal of any excess skin from the abdomen; this is the procedure that people know as a “tummy-tuck.” Again, this can be safely performed if the patient’s blood counts are monitored before and during surgery, and if you have a properly trained and efficient surgical team that can complete the surgery in a reasonable amount of time.
We also tighten the central abdominal (rectus) muscles to correct the separation of those muscles that occurs during pregnancy; this surgical maneuver helps reduce waist size as well. In addition to that, removal of fat from the flanks and removal of skin from the lower abdomen trims and enhances the waistline as well. In our facility, the procedure takes around 6 hours, which is significantly faster than what the Board of Medicine considers to be the standard of care, in terms of time, for these types of combined procedures outside a hospital setting. A patient usually recovers from the anesthesia within 1-2 hours and can then be discharged home. However, for comfort and convenience, we also offer the option of transfer to a VIP suite physically connected to our facility, in which the patient can recover the night following surgery. There, a nurse can provide all the postoperative care and monitoring needed, and keep the patient comfortable. The nurse has the ability to stay in contact with the physician, who can be rapidly available to evaluate the patient immediately after surgery. Pictures posted below show “before-and-after” examples of a patient who developed enlarged, sagging breasts, excess fat on the abdomen and back and a large abdominal apron after her pregnancy. Pictures taken one month later show the quick recovery and the dramatic changes the patient achieved in that short time.