Tummy Tuck in Boston: Abdominoplasty and Pregnancy
Abdominoplasty and Pregnancy
Boston Abdominoplasty specialist, Dr. Richard A. Moss returns to this week’s blog posting to discuss tummy tuck surgery and pregnancy. His previous posting dealt with breast augmentation and pregnancy. An important focus of Dr. Moss’ practice is that of mothers looking to improve their breasts and body after bearing children. In some instances, after having abdominoplasty and breast augmentation surgery, his patients remark that now their abdomens are flatter than before pregnancy and their breasts can nicely fill an unpadded bra.
Although it is well known that pregnancy has a marked and adverse effect on the appearance of the abdomen, many women learn only after they have had children just how devastating these changes are. They never had any idea that their bodies would not return to their pre-pregnancy state once they lost the weight that was gained over the nine months of pregnancy. And for some, the weight gain and inability to lose all of it is an issue in itself.
These pictures show a woman who has had one child. Her post operative pictures are fairly early in her recovery. It will be a few more months before she reached her final medical result.
Initially, a new mother may find just taking care of the new baby is so overwhelming that she barely notices the state her body is in. She may have to return to work full time, after less than two months off. It may take months before she even gets to sleep through the night and years before she feels she has a moment to think about herself. But when she does start thinking about herself, one of the first things that many mothers focus on is their abdomen.
Some mothers may come in to see Dr. Moss as soon as their baby is six months old while others wait a few years until they are more adjusted to motherhood and can find the time. Some need to wait until their finances can allow them to have abdominoplasty surgery.
This woman had two young children. Her scars are more noticeable; however scarring is beyond the control of the surgeon. Some patients just scar more noticeably than others.
Just exactly what effect does pregnancy have on a woman’s body? The following is from Dr. Moss concerning the effects of pregnancy on a woman’s body: “Pregnancy will cause a woman to gain weight. After delivery women will make an effort to lose that weight, however some portion of it can be permanent. Pregnancy also stretches out the abdominal wall and although exercise can improve the abdominal muscle tone after delivery, often the abdominal muscles, called the rectus muscles, are permanently separated. This condition, called diastasis recti, will cause a noticeable pouching out, particularly in the lower abdomen. Finally, the process of abdominal wall stretching will necessarily stretch the overlying skin. After delivery, that skin will usually shrink back, but this takes time. Often complete shrinkage will not occur and the patient is left with a significant skin sag, particularly in the lower abdomen.”
This is typical of a patient who needs an abdominoplasty. Some patients may also have significant stretch marks in the abdominal area.
For many women what this all means is that clothes no longer fit right and they are uncomfortable and embarrassed by how their body looks. Some women have even told me that they begin to schedule their family’s social life around the appearance of their abdomen. Translated this means no pool parties or no trips to the beach.
Some women try the exercise route and while this may put them in the best shape they have ever been in, they still may be left with considerable abdominal skin sag or pouching. And then there are those unsightly stretch marks. Let’s set the story straight about these stretch marks. Dr. Moss is unaware of any product or treatment that removes stretch marks. However, if the patient is lucky enough to have the stretch marks or majority of them in the area of skin that is excised, then they are gone. If the stretch marks are above the umbilicus or on the patient’s side flanks then sadly to say they will most likely remain after the tummy tuck procedure. Most women are accepting of this if they can at least correct a substantial part of their abdominal appearance.
How does abdominoplasty surgery correct all these problems created by pregnancy? There are two components to abdominoplasty surgery. The obvious one is that the redundant skin is removed. Dr. Moss utilizes the “progressive tension suturing method” which spreads the tension of the abdominal flap over the entire abdominal area rather than just at the incision. This allows for a faster recovery time and no drains. It may also provide the patient with a better scar as there is less tension on the incision as it heals. Many patients choose Dr. Moss because he is one of the few plastic surgeons in the Boston area who perform abdominoplasty surgery using this advanced method.
The 2nd lesser known component is the plication of the true abdominal wall (rectus muscle). Often it is a bulging rectus muscle that causes a woman’s abdomen to bow outward after pregnancy. Dr. Moss plicates this muscle in a corset like fashion which provides the patient with a flatter abdomen. Thin patients who do not have a large amount of excess skin, yet still have a bit of a pregnant look to their abdomen find that they gain more from this segment of the surgery than the removal of excess skin.
This patient had more of a problem with the bulging of her true abdominal wall (rectus muscle). Although it is not that apparent for the pictures she did have some excess abdominal skin that was removed.
This patient had more of a problem with excess skin.
She achieved a very nice result after abdominoplasty surgery.
How soon can a woman have abdominoplasty surgery after delivering her baby? Dr. Moss provides all of his patients who ask this question with the following answer. “It is my recommendation that women wait a minimum of 6 months after delivery of a child before considering abdominoplasty so that each of these conditions can be evaluated. If the patient is having continued improvement for one of these conditions, for example, is continuing to loose weight, then we would likely wait even longer until a stable condition has been reached and no further spontaneous improvement is likely. Previous C-sections do not constitute a problem if someone wants an abdominoplasty. It is worthwhile to mention that most patients report that the post-operative pain from a C-section is worse than that from an abdominoplasty.”
What about future pregnancies after abdominoplasty surgery you ask? Keeping in mind that tummy tuck surgery costs around $8000 and it is surgery requiring anesthesia and an overnight in the hospital, Dr. Moss has the following opinion: “It would be reasonable to wait until after a woman has had all her children before having an abdominoplasty. However, this is not always acceptable to a patient. For instance, if a woman has unacceptable skin sag or a markedly protuberant abdomen, then she may wish to have these deformities corrected with an abdominoplasty even if she plans additional children, particularly if she plans these pregnancies years in the future.
If after an abdominoplasty a patient wishes to become pregnant, there is no reason why this cannot be done safely. After abdominoplasty, there are no special recommendations that have to be made to successfully carry a pregnancy to term. Although there are meaningful medical reports documenting no loss of the benefits from an abdominoplasty followed by pregnancy, this cannot be expected in all cases.”
This woman is very typical of Dr. Moss’ abdominoplasty patients. She is in her thirties and has two young children with no plans for future children.
We find because of the expense involved and the fact that another pregnancy can cause the problem to reappear, most women will wait until they have had all of their children before they undergo abdominoplasty surgery. In fact, while most of our patients have young children or teenagers, it is not uncommon to have women in their 50’s and 60’s choose to have abdominoplasty surgery.