How a mommy makeover can TRANSFORM your body (with real results!) [Dan Zegzula, MD, Portland]

Eva Sheie (00:00):
You're listening to Where Before Meets After. Give me the overview of the mommy makeover procedures.

Dr. Zegzula (00:06):
Very commonly, mommy makeover is a combination procedure where a procedure is done on the tummy and one is done on the breast at the same time. The tummy procedure could be any version of body contouring in the tummy. It could be a tummy tuck, it could be a mini tummy tuck, it could be a more extensive circumferential tummy tuck where it goes all the way around your torso to tighten up the skin and remove extra skin and fat. And it might just be liposuction, and you would combine that with a procedure on the breasts, such as a breast lift, a breast augmentation, or a breast reduction depending on the patient's goals and their anatomy and their desires. Other procedures that may also be performed could be liposuction, liposuction of the flanks or the back, liposuction of the lateral breasts after a breast reduction is frequently done. And sometimes part of a mommy makeover may also include vaginal rejuvenation, although not as common. I don't think it's as commonly done in combination with, say, a tummy tuck as breast surgery would be combined with a tummy tuck more often for a mommy makeover.

Eva Sheie (01:08):
If you do both of these procedures, how much recovery time are you looking at?

Dr. Zegzula (01:12):
The recovery after mommy makeover is mostly determined by the abdominal component. Tummy tuck for most patients also includes repair of the abdominal muscles called the rectus diastasis. That's a separation that can occur to the rectus abdominus muscles at a term pregnancy. And we try and repair those muscles with a series of sutures bringing them back together in the midline. And that part of the operation is what causes the most discomfort and the slowest, and that's the slowest part of the recovery. For that reason, it's kind of determined the recovery is kind of determined by the abdominal components. And it may be a full four or six weeks before significant exercise is allowed because we want that muscle layer to fully heal before challenging it with activity that involves contracting the abdominal muscles with force. Walking, swimming, light yoga and Pilates can be done usually within the first month after a tummy tuck.

Eva Sheie (02:10):
This is a mommy makeover. This is all your photos are on your photo gallery. Can you kind of talk us through what you see here both before and after?

Dr. Zegzula (02:19):
So this is a really good example of the changes that we can make in a patient's abdomen with a tummy tuck as part of a mommy makeover. And the pictures on top, the two pictures on top are the befores and the pictures on the bottom are the after pictures and the changes that you can see are dramatic. First of all, look at the roundness of the patient's abdomen in the upper pictures. That roundness is what we see when you have rectus diastasis and separation of the abdominal muscles. So there's also extra skin and some extra fat, and you can see that most clearly because of the small skin apron that she has or the deep crease down by her groin. And on the hip area, she's got a lot of extra subcutaneous fat. So in this particular tummy tuck procedure, we performed a full tummy tuck.

(03:20):
It wasn't the circumferential, we didn't go all the way around because you can see where the end of her scar is. But in this operation, we removed the excess hanging skin of her lower abdomen. To do that effectively, we repositioned her belly button and then we got access to the abdominal muscles, brought those abdominal muscles together, so tightened her abdominal muscles. And you can see a very nice outline in the lower pictures of her abdominal muscles now. Her abdomen is flat because the abdominal muscles have been tightened. The skin is tighter because the excess skin has been removed. The belly button has been repositioned. And then we also performed liposuction on this patient's waistline, so some flank liposuction. And that's why she has such a nice hourglass shape to her waist at the end of this procedure. So it was a combination of skin removal and skin tightening, muscle tightening or muscle repair and liposuction to the waistline to give an hourglass shape. And then she has a natural appearing belly button and a low scar. You can imagine in a swimsuit that would easily be hidden and bikini bottoms with a much improved abdominal contour.

Eva Sheie (04:35):
I don't think it's widely known how much diastasis recti can make your belly protrude. So I know you did lipo here, but how much of her appearance in the before photo is a result of that diastasis versus excess fat?

Dr. Zegzula (04:50):
That's a good question and that's a good thing to point out and that's part of my discussion with patients when they're seeing me for a tummy tuck. And I'll tell them how much of your result is going to come from skin tightening and how much of it is going to come from muscle repair? In slender patients, patients who run a lot, they have low body fat content, sometimes they present with a very rounded tummy, almost like a small beach ball or basketball under their skin. And if you ask them to contract their abdomen and they can make that abdomen go flat, but as soon as they relax, that roundedness comes back. That's due to the rectus diastasis and those patients will get most of their result, 80% of their results sometimes, from the muscle repair. Other patients you can see when they're holding their abdomen, they have a flat abdomen, they have extra skin that hangs and is loose and they'll have some extra fat.

(05:42):
And those patients, the majority of the results going to come from the skin reduction in the fat reduction with the liposuction, and that's going to give them most of their result. Everybody it's going to be, you're going to get some on both parts of it, some from muscle repair and some from skin reduction, but in some it's way over to the muscle repair side of things for the result. And in others, it's way over to the skin side. On this patient, I think it's about 50/50, you can see the roundness to her abdomen and that is all due to muscle. She also has quite a bit of subcutaneous fat in the flanks and a bit of extra subcutaneous fat in the tummy, and so she got quite a bit of result from the skin reduction and the liposuction, but for her it was about half muscle and half soft tissues that helped us get this kind of a result.

Eva Sheie (06:29):
And there's no way to fix that, those muscles with exercise,

Dr. Zegzula (06:33):
People who have really significant rectus diastasis can improve with physical therapy. And it's not the kind of exercise where you can watch a YouTube video and then do the exercises at home and get it fixed with a well-trained, certified physical therapist. And it'll be an abdominal wall retraining and sometimes even pelvic floor retraining, you can get an improvement. But just like a rubber band that has been stretched too far and it won't contract all the way down, you'll sometimes you just need to have the muscles repaired surgically to get the abdomen completely flat. Surgery is the answer for many patients, but physical therapy can be very helpful, especially having that physical therapy and getting as much as you can out of it before surgery puts you in a position where surgery does the rest. You've done what you can, but surgery does the rest.

Eva Sheie (07:23):
Okay, let's look at another view of her. Let's look at her back. Very different.

Dr. Zegzula (07:27):
Yeah, you can really see the effects of her liposuction. The back rolls have been eliminated and her hip area, the flank area, has now been brought down to give her that hourglass shape with a well-defined waistline, no skin folds. So she had an excellent result from her liposuction, which I think included her back as well. It wasn't just the flanks. If the flanks being that area on either side of where the tattoo is and the back being above that area, I think she had liposuction in her entire back to get this result.

Eva Sheie (07:57):
Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of The Axis.