bodypostbaby's blog

OUCH!

I have a friend who lives in LA who just had a tummy tuck and breast augmentation.  She is on her first day after surgery.  She is a tough cookie, and her words to me today were, “This really hurts!!”

One of the most common mommy makeover surgeries is breast augmentation and tummy tuck.   These by themselves are the two most painful surgeries we do as plastic surgeons.  These surgeries hurt because of the muscle.  For tummy tucks, I like to put in a pain pump which drips numbing medication internally to help.  In addition we give you pain medication and some of us use muscle relaxants as well.  Even with all of this, it still hurts.

For planning how to deal with your family life (as you are a mom, hence the mommy makeover):

• the first 2-3 days you are OUT. You will be on medication round the clock.  Someone else should care for your kids.  And you. 
• The first one to two weeks you will be very sore.  No driving until you are off pain medication.  As for when you will feel normal again and be doing your daily life things, people vary.  Every person is different as to when they get over the “hump” and feel better. 
• No heavy lifting (yes, this includes your adorable children) until much farther out.  Exactly when you can lift something over 5-10 pounds is not a hard rule.  Some of it depends on you and your tissue.  Your doctor will know what that means.  Here plastic surgeons differ on their recommendations for activity level, so defer to your doctor.  Tensile strength of your wound (how strong your repair is) is weakest at three weeks out from surgery.  Usually you can’t do any exercise until at least 6 weeks out.  For core body exercise (pilates, crunches, that favorite daily method place in menlo park, etc) I extend that until 3 months.

Give yourself time.  It took you 9 months (and for those of you with multiple kids, multiply that time) to get into this mess, it will take you a while until you feel normal again.  This is normal.

Who doesn’t love that glucose tolerance test? Who can forget the “cola” flavor which 1. does not taste like cola, and 2. does not taste better when chilled.   Did you wonder why you had to do that? What is gestational diabetes?

Gestational diabetes is when you develop diabetes (high blood sugar) while pregnant.  You don’t want your blood sugar to be too high.  People with long term diabetes have issues all over their body due to problems with blood flow- heart disease, loss of sensation, loss of limbs, higher infection rates, vision issues to name a few.  In pregnancy, diabetes is associated with higher birth weight of your baby, early delivery, higher C section rates, diabetes in the mom, and future diabetes and obesity in your child. 

A study came out in the American Journal of Obstetrics and Gynecology of 65,000 women studied from 1991-2008 at Kaiser.  It showed for recurrent gestational diabetes:

• if you have gestational diabetes with your first child, you are 6x more likely to have it again with your second pregnancy
• if you have it with your first two pregancies, you hae a 26X risk for having it with your third pregancy
• higher rates found in Hispanic women, and Asian/Pacific Islander women
• higher recurrence in women over age 30
• higher recurrence when bigger time gap between pregnancies

This may seem like a “of course that makes sense” kind of thing.   But for those women who have had gestational diabetes, are older, or are certain ethnicities, that glucose tolerance test is extra important.

I had a patient who after three kids wants a tummy tuck.  Her belly was blown out after her second child, and she has back pain, so we knew a tummy tuck was in her future to repair it all after her third child.  She wants to do it when her baby turns one.

But she has been reading my blog (Go Bay Area blog reading mommies!) and said, “I know I should wait for 2-3 years until I do surgery, but I don’t want to wait.”   I realized I have not been clear.  It is true, the most common time I see women after babies is about 2-3 years out.  I think that timing is good- you have gotten out of the fog of babydom and given yourself a chance to get back into shape and see what comes back … and what doesn’t.  So the flip of that…

When is the soonest? Should you wait?

• Normal blood level.  You lose a fair amount of blood after birth.  You need 3 months to rebuild your blood store.
• Nutrition.  Your baby has spent the last 10 months preferentially getting your nutrients.  You need time to restore. 
• Sleep.  Surgery is a stress on the body.  I liken it to running a marathon.  If you are sleep deprived you won’t have the reserve to help you heal well.
• Breastfeeding.  Breastfeeding continues to take calories, energy, and nutrition for your newborn.  I am a HUGE breastfeeding fan.  The benefits to you and your child are immense.  If doing breast surgery, you need the breasts to be empty of milk, which takes about 3-6 months after you stop breastfeeding.  If doing other surgery, you can’t breastfeed at the same time- it would be too tough on your body to devote energy to healing and to your baby, and the medications needed for surgery and healing would get in your milk.  Also, see the nutrition point- breastfeeding can deplete you, so you need time after you stop to rebuild your internal stores.

My two to three year window is for women in the dreaded grey zone.  The grey zone? Those women who’s breasts and bellies aren’t like they were before babies, but they aren’t so bad.  In the right time of day, right angle, or if you stand up straight (posture girls!) you look okay.  Those are the women who should wait. 

But some women have things time will not help.  Particularly for the abdomen, horrible stretch marks, a wide diastasis (separation of the muscles), hernias, and hanging skin won’t go away with time and exercise.  Two years will not make these better.

So see your doctor.  Every patient and situation is different.  I get timing is tricky.  Many of you work, have multiple kids, and husbands schedules and other things you juggle.  But this is elective surgery.  And I know, from the title of this blog, you have an incredible responsibility- you are a mom. 

Elective surgery needs to be safe. 

There is a time and place for everything. Talk to your doctor.

As you are on this site, body post baby, I know a very important thing about you.

You are a mom.

The most wonderful, challenging, unpaid job in the world.  So cheers to you!  May your children appreciate you and all  you have done….

For charting and ovulation predictor kits and putting legs up in the air hoping to conceive, surviving the two week wait between ovulation and getting the positive test, to waiting to see the first heartbeat, and being scared any time you had a cramp or tinge of blood when you wiped that  something bad could be happening, to not having diet coke while pregnant, or alcohol, or advil, or blue cheese or one of the countless other no nos….

For birthing a 10 pound baby, or a baby with a big head, or enduring 24 hours of labor….

For the countless feedings, lack of sleep, lack of shower, and lack of everything for you, for breastfeeding, and pumping in cars and wedding reception changing rooms all for the health of your baby, for breasts which were sucked dry and now look sad, or breasts which now droop to your waist….

For not being able to suck it in anymore, or for having to suck it in all the time, or wearing your baby in a bjorn like a necklace so no one will make the mistake of asking you, the newborn mother, “remind me when you are due again?”

To motherhood.

We are a very very blessed bunch. I salute you.

Fat.

It is one of those things we discuss for our entire lives.  Watching what we eat, trying to fit into jeans, comparing ourselves to others while changing in the locker room.

A recent study in Nature magazine showed some interesting facts.  The basic jist:  the number of fat cells you have as an adult remains constant through your adult life.  They postulate that number is formed by the amount of fat cells you have in childhood and adolescence.  When you gain weight as an adult, you are enlarging the fat cells you already have.  When you lose weight, you are shrinking them.  As a kid though, when you put on weight, you add fat cells. 

Their thought? If you gained weight in childhood, you have more fat cells, and it is harder for you to lose weight as an adult.  For those who gained as adults, their fat cell number was determined when they were kids, so they don’t have as many cells, therefore  it may be easier for them to lose weight.  (Maybe this has something to do why some can lose the baby weight easier than others?)

• The number of fat cells rises until age 20
• The number then remains constant
• The number of fat cells is linked to BMI (your body mass index)

They found patients who had stomach stapling had no change in the fat cell number despite losing 18% of their weight.

Bottom line: Keep your kids healthy during adolescence.  Their fat cell number is set as an adolescent for the rest of their life.

Yes, yes.  I am a true believer in the benefits of breast feeding. 

I do not go into this starry eyed.  I know there is a cosmetic hit we breast feeding moms take (it is a lot of what I fix doing my mommy makeover work.)  But if you aren’t going to do it for your child’s health (less infections, etc), or for your health (lowers the rate of diabetes and heart risk), then do it for your country.

Medical costs are soaring.  The government is becoming increasingly involved in medicine.  I saw a recent study published in the news about how breastfeeding for six months could save 13 billion dollars. (!!)  You mean I can make a dent in America’s staggering spending by breastfeeding my baby?

Yes.

This is not new news.  In March 2001, a study of “The Economic Benefits of Breastfeeding: A Review and Analysis” was published for the USDA  (Food Assistance and Nutrition Report (FANRR13):

“A minimum of $3.6 billion would be saved if breastfeeding were increased from current levels (64 percent in-hospital, 29 percent at 6 months) to those recommended by the U.S. Surgeon General (75 and 50 percent). This figure is likely an underestimation of the total savings because it represents cost savings from the treatment of only three childhood illnesses: otitis media, gastroenteritis, and necrotizing enterocolitis. This report reviews breastfeeding trends and previous studies that assessed the economic benefits of breastfeeding”

http://www.ers.usda.gov/Publications/FANRR13/

The recent numbers are an extension of the original study, which only looked at three major illnesses, and wasn’t corrected for today’s economics. 

So.  Breastfeed- For your baby, for your health, and for your country.

I just got back from a playgroup. There was a mom who just had twins 6 months ago and has another child who is 2.  She had tried to do an intense exercise and diet program to get back into shape.  Here is a woman who has three kids within 2 years, the twins are boys, she is not sleeping through the night.  I was looking at her thinking, “You showered!” “Your shoes match!” “You aren’t wearing sweats!”  So I will repeat what I, the plastic surgeon and mother of three said to her:

Give yourself a break.

I know it is tough.  We see magazine articles of “how famous so and so actress lost her baby weight in three months!”  And there will be some lovely article about broiled chicken and fish and salad and yoga.  Or better yet, “I lost the weight just chasing after my kids.” Oh how lovely.  Here in the Bay Area there are many uber athletic thin women.  Some women I know look smaller when they are 9 months pregnant than the average American woman is non pregnant. 

Give yourself a break.

There are those genetically blessed women who “pop” right back into form quickly.  Yes, it isn’t all genes.  Keeping in shape while you are pregnant, not gaining more than the baby weight, not using pregnancy as carte blanche to try all the flavors of Ben and Jerrys … these all are important. 

But at six months out with a new baby, particularly if you have other children, and are breastfeeding/ working/ making dinners/ laundry/ cleaning up/ making lunches/ bathtimes/ buying diapers/ afterschool activities/ playgroups/ clean the house again…

There is a time and place for everything.  Sometime not so far away, your baby won’t be a baby.  He will be sleeping through the night.  YOU will be sleeping through the night.  I see the majority of my mommy makeover patients 2-3 years after their last child.  I think that timing is good.  It gives you time…. time to enjoy being a mother.  Time to breastfeed.  Time to give your body a chance to get back to normal.   Then you can work out.  Diet.  Exercise hard.  See where you can get to on your own.   

So give yourself a break.  Your baby won’t be a baby for long.  Savor every moment while you can.

I know this isn’t really about plastic surgery.  But being a working mom, I loved this study which looked at kids and obesity.  One of the questions raised in recent times is whether childhood obesity rates going up has something to do with more mothers having to work.  In 2000, the New York Times reported for the first time since the Census Bureau began tracking numbers, families in which both parents are working is the majority, including the traditional married with children group.  Here in the Bay Area we know most of us can’t afford our house without two working parents.  

This study out of Australia, to be published in the Journal of Social Science and Medicine, looked at 2500 children at two different points- ages 4/5 and again at 6/7.  There were three groups of moms: stay at home, full time working, and part time working. 

Findings (Dum ta dum dum drumroll): Mothers who worked part time were more likely to have healthier children than either of the other groups.  They found those children watched an hour less of TV per week and had a healthier lifestyle. 

Full time career women had higher rates of overweight children.  The thoughts were they had fewer home cooked meals and less time to encourage active, physical play.

Stay at home moms? Unclear why they were more likely to have overweight kids, but they postulated the part time working mom might balance work and family demands better. “They reschedule activities, sleep less, and allocate less time to personal care and leisure to ensure that time with children is protected.”

Regardless, it was good for me to read.  It is nice to know stay at home moms and full time working moms were in the same boat, and part time working moms fared the best.  So working isn’t the issue.  Balancing and scheduling well seems to be the ticket.

Ooooh.  Or perhaps this means we all need a day or two off a week.  As the study shows,  it is better for our kid’s health and weight….

I get People magazine at my office. 

Yes, yes. I admit.  I flip through it.  A guilty pleasure I am sure.  It is a bit of “plastic surgery” research though as well.

This will be a quick post, but The March 8 2010 issue had on the front cover, Nicole Eggert. “How I lost 15 pounds!” So I read the article.  I saw the photos.

She did lose weight.  She does look better.  But I have a strong suspicion this was not just her eating plan of not skipping breakfast, eating a large salad for lunch, and broiling fish for dinner.  So I searched online to see if anyone has the scoop on what she did.  In looking at her photos, I can’t quite see her moles on her 2009 photo to compare to her current one.  In her 2010 photos she is lifting her hands above her head (we all look better that way), so I can’t quite tell how tight her skin really is.  Why would I look for moles and skin tightness? My strong suspicion is she had liposuction, a tummy tuck, or a mini tummy tuck. When you have a tuck, your skin is tightened and walah, your moles would move.

So why am I writing about this? Trust me, I am a busy surgeon.  I am not searching gossip columns to dish on celebrity surgery.  But this People magazine article makes me mad.  Women who have children frequently don’t have the bodies they did before having children.  And for many, it is not eating too many hamburgers and being a couch potato which causes it.  I have many patients at their ideal weight, who do work out daily and eat well, and “can’t tone things up.”  They can’t tone it up because their muscles are separated and their skin is stretched. 

I don’t want people to read this article and think “If I just eat broiled fish for dinner, I can look like that too…”  This is misleading.  This is not the whole story.

So I don’t know what she did.  I am glad she feels better and is in the best shape of her life.  She looks great.  But we mortal women who have had children should not read these magazine articles and think they are reality.

Though maybe we should all raise our arms over our head when we take photos.  It is a simple thing to do.  And that will make our bellies look better.