Aesthetic Trends and Technologies™
The leading physician journal for aesthetics and wellness

Boris M. Ackerman, M.D.
Board Certified Plastic Surgeon
Newport Beach, CA

The birth of a child is one of the most exciting events in a woman’s life. However, it is often distressing, especiallyto first-time moms, when their bodies do not spring back into pre-pregnancy shape, often leaving them with saggingbreasts, stretched abdomens, and an overall matronly feeling. Motherhood now has a new shape. Thanks to advancesin cosmetic surgery, postpartum mothers can now reclaim their bikini bodies faster than ever before. Many women,although ecstatic about newfound motherhood, are riddled with insecurity after childbirth due to excessive weightgain in areas which may not have been troublesome before. Women primarily seek two forms of surgery as postpar tum “tune-ups”— abdominoplasty (commonly referred to as a tummy tuck), and breast enhancement surgery(including breast lift and breast augmentation).

Unlike women who are simply overweight, pregnancy puts a certain strain on the body which cannot always be com bated by diet and exercise alone. The midsection of the abdomen can be compared to a girdle, a garment which iscomposed of an elastic portion which, when stretched, is likely to become one size too big. In the abdominal section,women often lose the desired “girdling” effect after childbirth, which can occur in varying degrees. Pregnancy notonly weakens the muscles, but stretches out the connective tissue, which for most women will not revert to originalform on its own. A tummy tuck not only targets excess skin, but also works to retighten the connective tissue so thatthe abdominal wall reacts to give the waistline a desirable indentation. Without tightening the connective tissue andexerting a girdling effect on intra-abdominal contents, women cannot achieve their pre-pregnancy appearance.

Breast augmentation and breast lift surgery are suitable solutions for postpartum women who are dissatisfied withthe new shape of their breasts. Most women, after having one or more children, start to lose volume in the upperportion of their chest, and get a hollowed appearance in the upper outer quadrant of the breast. I also notice thatwomen begin to show signs of sagging in the lower portion. The sagging of the breast is referred to as breast ptosis;and in such cases, I may perform a mastopexy (breast lift), and often insert an implant in the breast to replace the lostvolume. The size of a woman’s breast depends on the volume of tissue in the breast; but the position of the breastdepends on tautness within the skin envelope, which retains that volume. If a patient has sufficient volume, I simplylift it, giving the woman a tighter skin envelope, thus making the breast stand high and firm.

Many women begin to feel psychologically affected after childbirth. With a fair amount of weight gain, women mayfeel undesirable, unmotivated, or even frustrated if they are working out at the gym and still cannot seem to shedthose last few pounds. By tightening a woman’s body, a surgeon can improve a woman’s self-esteem and her overallattitude about herself.

What about liposuction? Is it still a viable option for someone who wants to rid himself or herself of unwanted weight? A good candidate for liposuction is someone who is in fairly good shape, relatively close to his or her ideal weight, but wants to trim down localized areas. The person should be physically healthy, psychologically stable with realistic expectations. The fat will not re-accumulate in these areas in the same manner as before and leaves small, if any, scars. I have many patients who come to me after they have given birth and request liposuction. Even though they have returned to their previous weight, many of these women have some resistant areas as a result of the preg nancy. One common place where women retain fat is the outer hips. These patients are ideal because the fat is localized so it is not difficult to suction and sculpt the surrounding area to create the desired contour.

Mini tummy tucks are also for someone who is basically in good shape and may be recommended for patients who are within 10% of their ideal body weight. This procedure is less invasive than a full tummy tuck. A mini tummy tuck is a surgical procedure to remove excess skin and fat from the middle and lower abdomen and tighten the muscles of the abdominal wall. The procedure can dramatically reduce the appearance of a large or protruding abdomen and can significantly narrow the waistline. The surgery is ideal for women who have been pregnant and have stretched their abdominal muscles and skin beyond the point where they can return to normal, thereby resulting in “stretch marks.” I advise my patients not to undergo a tummy tuck until they are done having children. There have been a number of case reports where women have accidentally become pregnant after having had a tummy tuck and deliver the baby successfully. However, theoretically there are potential problems which can occur. Aesthetically speaking, if a woman becomes pregnant after a tummy tuck, there will be new damage to repair after the delivery. For this reason, I would not advise women to undergo this procedure until they have completed their family.

Some women even opt for a C-section with a tummy tuck. These two procedures can be done in combination, but I advise against it because the body needs time to re-stabilize. Right after delivery, the tissue of the abdomen needs time to shrink down, or the results will not be optimal. A woman should allow for some time to return to her pre-pregnancy weight and allow for the skin and muscles to rejuvenate. Women should wait at least 3-6 months after any delivery (C-section or vaginal delivery) to have abdominal surgery. The abdominal muscles need time to repair them selves from delivery before undergoing more surgery in order to yield the best results possible.

With the latest advances which modern plastic surgery has to offer, motherhood now looks quite different than it did a generation ago. Mothers can now revel in the joy of their infants, while knowing that they can quickly regain their pre-pregnancy shape and self-esteem.

Boris M. Ackerman, M.D., is a Board Certified Plastic Surgeon specializing in facial rejuvenation with Endoscopy and Laser Liposculpture and Breast Surgery. He was one of the first surgeons in California to utilize the laser in plastic surgery. Dr. Ackerman has been in private practice in Newport Beach since 1987. He graduated from the Massachusetts Institute of Technology and received his Doctorate of Medicine from the Dartmouth Medical School. He performed his postgraduate training at Cedars-Sinai Medical Center in Los Angeles. Dr. Ackerman is on staff at Hoag Hospital in Newport Beach. He is an active member of the American Society of Plastic and Reconstructive Surgeons and the Orange County Medical Association. He was recently seen on the Discovery Channel’s Plastic Surgery Before and After, and MTV’s I Want A Famous Face. For more information, please visit www.doctorackerman.com.