Few things in life bring as much joy as having children. As parents, we lovingly sacrifice for our children. These sacrifices may come in the form of lack of sleep, crazy carpool schedules, and financial investments for their future.
Pregnancy, however, can take a toll on a mother’s body during the growing, nurturing and feeding of a baby. A woman’s body changes in a multitude of ways during pregnancy - the hips become wider to allow the passage of a baby through the birth canal; the skin of the abdomen stretches and grows to accommodate a growing fetus, soon to be an infant child.
Add to this breastfeeding. A woman’s breasts not only go through the enlargement that pregnancy brings but also the changes that providing sustenance and nourishment for a child brings.
Some of these changes, thankfully, are reversible. The average weight gain during pregnancy should be about 30-35 pounds. The majority of this weight can be safely lost during the baby’s first year with a healthy regimen of good eating and exercise. Breastfeeding can assist in this weight loss by helping the body burn calories that have been stored during pregnancy.
But what about the changes associated with pregnancy that does not respond to weight loss? What about excess skin on the abdomen? What about stretch marks? What about the now sagging breasts? These problem areas do not always respond to dieting and exercise. This is where the “Mommy Makeover” comes in.
According to the American Society of Plastic Surgeons, breast augmentation or breast enhancement surgery, is one of the most popular cosmetic surgical procedures performed in the U.S. The number of women having breast augmentations has increased by over 50 percent since 2000. Abdominoplasty, or “tummy tuck,” is also a commonly performed procedure, with a 133 percent rise during the last decade. The increasing popularity of these procedures mirrors the increasing popularity of plastic surgery in the general population.

A “Mommy Makeover” is a combination of procedures that restore a woman’s body to its natural, pre-pregnancy state. The goal is to bring back to form what was stretched-out during the growing and nurturing of a child. For many women, this may start with an abdominoplasty, which tightens the excess skin of the lower abdomen, leaving a scar that can be hidden low in the bikini line. Often, many of the stretch marks of the abdomen can be removed with this procedure. The muscles of the abdominal wall are tightened to improve the “tone” of the abdomen. Liposuction is often performed to additionally contour the abdomen.
The changes in a woman’s breasts are the next area to be addressed, many times during the same operative procedure as abdominal contouring. Often, women complain that they are “empty” or “deflated” and “droopy” or “low.” Breast implants can be used to replace the volume of the breasts, and a breast lift might be recommended to tighten the skin of the breasts to a more natural, youthful position.
Breast implants come in a variety of sizes and shapes, not to mention materials. Although saline implants are still more commonly used, some women prefer silicone implants for its ability to mimic the “feel” of a natural breast. We will discuss in detail the risks, benefits and difference between the two styles of implants to help you make a choice that is best for you and your lifestyle.
Other concerns may be addressed during a “Mommy Makeover” such as unwanted fullness in the hips, thighs, and arms. These areas can be contoured with lipo-sculpture, or liposuction to improve your overall proportion.
A “Mommy Makeover” may be performed in a single operation or in staged procedures, depending on your general health and of the complexity of the operation. Also, depending on the length of the procedure, an overnight hospital stay may be recommended as well. Safety should be the guiding principle of any elective surgery.
Nothing should overshadow the joy that pregnancy and raising a family brings. As a mother and surgeon, I understand that the changes you see in your body with pregnancy are simply that. Changes. These changes associated with pregnancy, motherhood and aging affect each woman differently and can be improved upon with new advances in surgical techniques. A consultation and examination is your first step toward a “Mommy Makeover”. We will listen to your concerns, assess your problem areas and discuss which options will help you achieve your desired results.

When considering breast augmentation surgery, there are several choices and decisions that women will want to make to ensure they are well informed and pleased with their surgical results. These options include incision placement, implant placement (above or below the pectoralis muscle), ultimate breast size and implant type (saline vs. silicone).

Until recently, women seeking breast augmentation were limited to saline-filled breast implants. In November 2006 the FDA released its previous restrictions on silicone gel implants and now all women over 22 years of age have the option to choose between saline and silicone implants for cosmetic surgery. From 1992 until November 2006 silicone implants were available, but with significant restriction imposed by the FDA. Silicone breast implants were allowed for women undergoing breast reconstruction or revisional breast surgery if they already had silicone gel implants. During this period of time, studies were ongoing about the safety of silicone breast implants. This period of time also allowed surgeons to become more experienced with saline filled implants and to evaluate the satisfaction of women undergoing breast augmentation with saline filled breast implants.

Both saline and silicone implants have solid silicone outer shells. Saline implants are filled with a sterile salt water solution during the operative procedure to reach the desired size. Silicone implants are pre-filled with a gelatinous “cohesive” gel silicone. Many women feel that silicone implants feel softer, and may more closely resemble the texture of natural breast tissue. Saline implants do not have this same “gel-like” consistency and there is a greater potential for palpable or possibly visible rippling of the implant.

There is more information to consider when choosing a breast implant. Both implants have the potential for rupture. Although statistics vary, women can assume a 10% rate of rupture in 10 years, and approximately a 30-40% rate of rupture in 15 years. The ability to detect a rupture varies between the two styles of implants. When a saline implant leaks, your body absorbs the salt water fluid, and you will notice a decrease in breast size over a period of hours or days. Diagnosing a ruptured saline implant does not require a radiologic examination, and the deflated implant can be easily removed and replaced with a simple operative procedure.

A rupture silicone implant is more difficult to detect. The shape and feel of a ruptured silicone implant may be the same to both the patient and physician because the silicone gel tends to remain cohesive in the implant pocket. It may even be difficult for a routine mammogram to diagnose a ruptured silicone implant. For this reason, the current recommendations by the FDA are that you undergo an MRI breast evaluation every 2-3 years following surgery to detect a ruptured silicone implant. Although not a dangerous exam, the cost of repetitive MRI examinations can add up over the years. When a ruptured silicone implant is diagnosed, the gel implant is not as easy to remove as the removal of a ruptured saline implant. Therefore, women need to be aware that there may be a more extensive surgical procedure with a longer recovery time associated with revisional silicone implant surgery.

The incidence of capsular contracture also varies between saline and silicone gel implants. All women form some type of scar around their breast implants. A capsular contracture is abnormal constrictive scar tissue that develops around an implant that may distort the shape of a woman’s breast and can make the breast feel unnaturally firm. We do not know for sure what causes capsular contracture, but it appears to be more common with silicone breast implants, particularly those placed above the chest wall muscle (sub-glandular placement). Silicone bleed (gel leakage from a silicone implant) has been implicated as a cause for the increased risk of capsular contracture, and well as the possibility of a sub-clinical infection.

The development of a capsular contracture does not mean a woman needs to have secondary surgery, however if the scar tissue is distorting the shape of her breast or creating breast discomfort, she might be considering revisional surgery. The surgical procedure to remove constrictive scar tissue is more extensive with silicone implants, and therefore women again need to be prepared for a more extensive operative procedure with a longer recovery time.

Saline and silicone implants can be placed via the traditional breast implant incisions: transaxillary, periareolar and inframammary fold. Since saline implants are filled during the operative procedure once they have been placed in the pocket, they can be placed through smaller incisions. Silicone implants come prefilled, therefore the incision has to be large enough to acodomate the size implant being used. Typically these incisions are at least twice as long as the incisions needed for saline implant placement.

The choice between saline and silicone implants may not seem so obvious when one considers not only the feel or texture of the implant, but also the maintenance and revisional surgery requirements with breast augmentation surgery. The women that may notice the most difference between the feel and look of saline versus silicone implants are those with significant skin relaxation from prior pregnancy or weight loss, and those women with minimal breast tissue prior to surgery. It is important to have a good understanding between the two types of breast implants prior to consenting to any breast surgery procedure that involves the use of implants.

At The Women’s Center, we will discuss these options in detail. Recent studies show that the satisfaction rate with saline filled implants is above 93%. With silicone implants now an option for women 22 years of age and older, it is important for you to have a good understand of the advantages and disadvantages of each implant to make an informed decision. Every patient is unique and has individual concerns and goals for surgery. We will thoroughly discuss your options so you can make an informed decision on the surgery that will meet your specific needs and lifestyle.

Women struggle for satisfaction with themselves and their bodies much, if not all of their lives. While the reasons for this struggle are varied, there are common factors which affect all of us. Whether in magazines and advertisements, or television and movies, we are constantly faced with images of thin, lean, beautiful women.

It is no surprise that many women are preoccupied with body image. According to one American study, approximately 80-90 percent of women dislike their bodies.

The perception of our bodies begins at a very early age in life. Childhood messages about our bodies form the foundation of our body image later in life. The way family members react to the changes we encounter and comments from others is an important part of how our body image develops. How we perceive and internalize these childhood messages about our bodies determines our ability to build self-esteem and confidence in our appearance.

Body image is an individual’s perception of his/her physical self. It is the mental picture a person has of their body, as well as the individual’s associated thoughts, feelings, judgments, sensations, awareness and behavior. Body image is not a static concept. It is developed through interactions with others and the social world.

Thus, what society holds up as ideal is often what women strive for. Preferences for body shape vary over time and among all cultures. Historically, most societies have associated extra weight in women with desirable social status — an overt sign of wealth when food was not abundant. “Rubenesque” women were considered the epitome of femininity and beauty.

Because women today are inundated with beautiful faces and “perfect” bodies, we must strive to maintain a realistic and healthy body image. A healthy body image is evident when a person’s mental picture of her body is accurate, and her feelings, assessment and relationship toward her body are positive, confident and self-caring.

Healthy body image is more than the absence of struggles around food, weight or appearance. It is having the support and resources necessary to: 1) care for the body;
2) find outlets for self-expression; 3) develop confidence in one’s physical abilities and capacities; and 4) develop a positive self-concept.

Women today have resources to help them resist negative environmental messages, the most important being education and the awareness that we are all unique individuals. Good nutrition and regular exercise help to keep us both physically and mentally fit, as well as promotes a healthy body image. And sometimes cosmetic surgery is appropriate to help women feel better about their bodies and looks in general

Women who already have a healthy body image and desire to enhance, but not change their appearance, will generally benefit the most from cosmetic surgery. Striving for improvement — not perfection — is the key. Women who have realistic expectations can greatly improve their body image with appropriate cosmetic surgery. Of course, before having any cosmetic surgery, you should discuss any questions or concerns, as well as your expectations, with your physician.

It’s not about looking like a movie star or a runway model. It’s about being accepting and nurturing of the body you have. Since a healthy body image is directly related to self-esteem, it is important that women understand that the images in the media have nothing to do with realistic expectations. After all, what could be more beautiful than a woman confidant about her appearance, both inside and out!

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Diane Gibby, M.D., P.A., F.A.C.S
Dr. Diane Gibby is board-certified by the American Board of Plastic Surgery and the founder of The Women’s Center for Cosmetic and Plastic Surgery. Dr. Gibby’s office is located at Medical City Dallas, Building C, Suite 820, (972) 566-6477. Individuals interested in brochures or names of qualified plastic surgeons in their area may call the American Society of Plastic and Reconstructive Surgeons at 1-800-635-0635.