Intro: Duly Noted, a health and care podcast, is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners reimagine and better understand an extraordinary health and care experience.

Cheryl Martin (Host): Having a baby can change a mother's body, so to restore or improve the pre-baby shape, more mothers are having what's called a mommy makeover. And here to tell us all about it is Dr. Karina Alexander, a Duly Plastic Surgeon. I'm Cheryl Martin, and this is Duly Noted, a health and care podcast. Dr. Alexander, what exactly is a mommy makeover, and how does it address common post-pregnancy body changes?

Karina Alexander, DO, FACS: Hi, this is an excellent question because the answer can be so different for different patients. So, typically, when we think of a mommy makeover, we think of a combination of an abdominal procedure like liposuction or abdominoplasty or tummy tuck with a breast procedure such as a breast augmentation or a breast lift.

And this makes sense as our belly and our breasts are the two main areas that undergo huge drastic changes during pregnancy and breastfeeding. But in reality, a mommy makeover per se can mean anything. It could mean a breast lift with a combination with a blepharoplasty or an eyelid lift, or it could mean just a liposuction, if that's really all you need.

It can be very different for different patients, but on average is typically considered to be an abdominal procedure with a breast procedure.

Host: So when it comes to patients for a mommy makeover, are they diverse in terms of age or do they predominantly fall within the late 30s to 40s age range?

Karina Alexander, DO, FACS: There is actually a very wide age range for patients seeking a mommy makeover. Typically, you would think of a woman in their late 20s or 30s seeking these type of procedures, but in reality, we've seen a trend towards older patients also seeking abdominoplasties and breast procedures. I think when you look at the numbers from the American Society of Plastic Surgeons in 2022, the mastopexy rate has skyrocketed over 37 percent when compared to 2019, and the rates of abdominoplasty also increased about 30%.

So, I think the trend is for more patients to seek these type of procedures and we're seeing older women even into their 50s now finding themselves as empty nesters and wanting to do something for themselves after, after raising their children for so long. So there's a huge variation from anywhere you know, from your 20s to your 50s.

Host: So, really, a mommy makeover at almost any time.

Karina Alexander, DO, FACS: Exactly. Yeah.

Host: So, you've talked about some of the procedures. Just want to make sure if those are the most common or if you want to talk more about what's included in a mommy makeover and how do the procedures complement each other.

Karina Alexander, DO, FACS: Yes, so the standard mommy makeover that is referred to in the literature is a combination of an abdominal procedure and a breast procedure. And by abdominal procedures, we're thinking mostly liposuction or abdominoplasty. These procedures address the changes that happen in our abdomen after pregnancy, the stretching of the skin and the separation of the muscles.

With an abdominoplasty, you're kind of targeting all of those areas by removing the excess skin and repairing what we call the diastasis recti, which is the muscle separation that happens. This will give you a more flat contour to your belly and really restore some of that core strength that sometimes gets lost. With an abdominal procedure also you can add liposuction and other different modalities to kind of help you reach your goal.

Breast procedures are the other side of the mommy makeover and this is can be different for different patients. Some women will need just a breast lift or a mastopexy in which we're just removing some of that extra skin to restore the more natural contour of a breast, more youthful appearance to the breast. Some women would benefit from the addition of a breast implant or a breast augmentation in order to give them a fuller cleavage or a nicer contour. And in some cases, it could either mean, it could even mean a breast reduction. So actually reducing some of the bulk of the breast in order to improve on the shape. And those are most typically common procedures that we see.

Host: Now, if a mother decides to have this procedure after the first child, and she gets pregnant again, and let's say may have two or three more children, would she have to consider another makeover, or will the first one be still effective?

Karina Alexander, DO, FACS: So, ideally, when you are, when someone is considering a mommy makeover, we really counsel our patients, with their family planning because additional pregnancies and fluctuation in weight can alter your results. Those can be unpredictable at times. I think, for the majority of patients, the results may hold, but there will be a number of patients that may require a revision or secondary procedures in order to correct some of those changes that happen with subsequent pregnancies.

Host: Okay. Now, are there any specific criteria or health considerations that determine if a patient is a suitable candidate for a mommy makeover?

Karina Alexander, DO, FACS: So, as we talked about before, ideally you want to have completed your family and not planning to have any additional pregnancies in the future. We also, want to make sure that your weight is stable, like, we mentioned before, this can really affect your result.

And of course, we want to look at your overall health, so any chronic medical conditions need to be well managed. Diabetes, high blood pressure, all of these things can really minimize your risk of complications, in addition to nicotine status. So, if you're a smoker, we really recommend you stop smoking before considering having any type of procedure, but especially these mommy makeovers as they can really impair wound healing after surgery.

Host: Dr. Alexander, walk us through the typical process from the initial consultation to the recovery period for mommy makeover.

Karina Alexander, DO, FACS: Sure. So, when you come into the office, we set aside some time to first go over your health history and this way we can determine if you are an appropriate surgical candidate. Then we take some time to talk about your goals and what you hope to achieve. And this way, we can narrow down which types of procedures may be appropriate for you. We, during the consultation, answer all of your questions and make sure that you're comfortable with everything. We take photos, measurements, then surgery is scheduled. Typically, I like to offer my patients a pre-operative visit usually a week or two before their surgery as a way to answer any last minute questions. And we go over all of the details of the procedure. Surgery typically takes place and then you get your postoperative evaluation about three to five days after your procedure, sometimes seven, depending on our schedule and your availability to come into the office.

For these type of procedures, we're looking at an overall recovery of about six weeks where you're expected to not do any type of heavy lifting or exercise while you are healing. But most patients can return to work within two to three weeks after surgery.

Host: Now, how soon after delivery would a mother be would be ready for a mommy makeover?

Karina Alexander, DO, FACS: For this question, I think it will vary for different patients. I think the things to consider is, are you back to your pre-pregnancy weight? Or do you anticipate losing additional weight? And with any breast procedure, we really also want to know about your breastfeeding status. Because, we ideally want to delay any breast procedures for at least 6 to 9 months after weaning or cessation of breastfeeding in order to reduce the risk of infections.

So, the timeline can change, but on average, I would say, if you're back to your pre-pregnancy weight and don't anticipate losing additional weight and have stopped breastfeeding, it could be as early as 6 months postpartum.

Host: Okay, what are some of the latest advancements or techniques in mommy makeovers that have improved patient outcomes and satisfaction?

Karina Alexander, DO, FACS: When it comes to, for example, breast procedures, we have a wide variety of breast implants, and the technology has changed drastically in the last few years. We have different fourth, fifth generation silicone implants that are, very safe and can provide the patient with their desired outcome, depending on the projection they want and the fullness that they want to have.

We also have the ability to add mesh support to the breast augmentation or the breast lift in order to provide a more long lasting result and prevent the breast from kind of drooping again. And when we talk about abdominal procedures, I had mentioned, addition of liposuction and different skin tightening techniques that can really take your results to the next level with high definition liposuction in addition to the abdominoplasty.

Host: Talk about if there are any potential risks or complications associated with a mommy makeover and then if so, how do you ensure patient safety?

Karina Alexander, DO, FACS: Yes, so I think this is why it's so important to have a thorough initial consultation with your surgeon, because at this time is a time where we identify any potential risk factors and issues that will need to be addressed beforehand in order to guarantee safety during and after surgery. So obviously, we want to make sure, like I mentioned, to have your chronic medical conditions well controlled.

Some of the more the common risks that we see with abdominoplasties, for example, is delayed wound healing, so incisions that take a little longer to heal. Those are all typically minor complications and we can guide patients post-operatively on how to manage these. Some of the more serious complications can include bleeding or even developing a, a clot or a thrombosis that can turn into a pulmonary embolism.

So these are actually some of the more more risky procedures for these type of risks, but I, again, during the initial consultation can identify the patients that are at higher risk and can take measures, like providing patients with anticoagulation or even involving other specialties to make sure that we are all managing these issues appropriately and minimizing the risk of complications.

Host: Dr. Alexander, how does a mommy makeover impact a patient's overall self esteem and body image after undergoing procedures? What have you noticed?

Karina Alexander, DO, FACS: I have noticed that patients are extremely happy after their procedure for the most part, and there are little things that I wouldn't necessarily expect to hear after surgery, but, it's almost, you know, seeing the patients before and after surgery, you can see a change in demeanor, patients look more confident, they're able to wear clothing that they probably hadn't you know, being able to wear for years before, they have become more social. So they're able to, go out more, even plan vacations, wear a bikini when they hadn't worn one in a long time. So I have seen positive change in the patient's lives after undergoing these type of procedures.

Host: That's great. So, what factors then should be considered when choosing a plastic surgeon for a mommy makeover?

Karina Alexander, DO, FACS: Excellent question. When you're considering undergoing any type of surgery, obviously, you want to find a surgeon that is well trained and has the, the ability to take care of you. So when looking for a plastic surgeon I think the first thing to look for is for board certification.

This means that your plastic surgeon has completed training that is recognized by the American Society of Plastic Surgeons and the Board of Plastic Surgery and that they have gone through the, the rigorous training process and are able to perform these type of procedures. When you're speaking with your plastic surgeon, ask as many questions as possible. Ask to see before and after photos.

You also want to ask about where the procedure is performed. Is it performed in an office space setting, in an ambulatory surgery center or at a hospital? Even if it's not at the hospital, you might want to ask if your surgeon is affiliated with other hospitals. And, obviously no one expects, or goes into this expecting complications, but it's not a taboo to ask your surgeon how complications are handled in the event that they do happen. It's always good to know what the process will look like in the event that you do develop one.

Host: Now, are there any non-surgical options available for mothers who want to rejuvenate their appearance without undergoing surgery?

Karina Alexander, DO, FACS: Yes, there's many different devices out in the market that address some of these concerns, mainly the extra skin. So there are skin tightening devices that use radio frequency or laser modalities that can help. With some degree of skin tightening. There are devices like CoolSculpting that address some of the stubborn areas, where we have fatty deposits, and they can help to a certain degree.

I think, at best, you know, the results that you get for with these could be moderate, depending obviously on the patient. With the breast procedures, it's a little more difficult. I think once you have some of those changes with, you know, extra skin in the breast and restoring some of the volume that has been lost, I think the best option really, involves surgical procedure.

Host: Dr. Karina Alexander, this has all been very informative. Thank you for sharing your expertise on such an important topic for mothers. New mothers or mothers, a little bit older than that. Thank you so much.

Karina Alexander, DO, FACS: Thank you.

Host: If you'd like to learn more, visit dulyhealthandcare.com. That's dulyhealthandcare.com. If you found this podcast helpful, please share it on your social media and check out the full podcast library for other topics of interest to you. This is Duly Noted, a podcast from Duly Health and Care. Thanks for listening.