December 2009

Ah. The joys of being female.  All those lovely “woman” things, sometimes can lead you to need a hysterectomy.  Ug.  But can there be a silver lining? If you have to have a hysterectomy, can you do this with a tummy tuck?

For those with no attention span, the quick answer: Yes.

But there are conditions….

1.  Hysterectomy needs to be done for a benign condition.  If you have cancer, you need to focus on the treatment and healing for that.

2.  You need to be healthy.  Hysterectomy is a big operation, which has blood loss, healing, yadda yadda.  I had a patient who needed a hysterectomy due to intense heavy bleeding each month.  She was a great candidate for a tummy tuck.  I would have loved to do them at the same time.  But she was anemic.  NOT OKAY to do tummy tuck.  A tummy tuck is a cosmetic surgery.  It lengthens the time of surgery, causes more blood loss, and increases overall risk.  If you are anemic, you won’t heal the long incision well- you have higher risk for infection, wound dehiscence (fancy way of saying your wound opens up), poor scarring, etc.

3.  A lot of benign conditions which used to treated in the past by total hysterectomy such as heavy bleeding or fibroids, can now be done by less invasive means such as ablation.  Can’t have a tummy tuck with a hysterectomy if you don’t need a hysterectomy.

Any combined surgery has higher risk of complication, wound infection, DVT/PE, and anesthesia reactions such as nausea, etc.  In healthy women, this additional risk is low, and the benefits of one anesthetic, one surgery, and one recovery outweigh the risk.  For busy moms and working women, doing the 2 for 1 is the only way they will get to have a tummy tuck.  But we must keep in mind this is elective, cosmetic surgery.

For those who fit the criteria and are healthy, go for it! I love buy one, get one free. It’s the like tummy tuck was on sale. What girl doesn’t like that?

Yup. That’s right. Go raid your kids toys. There is a use for those marbles.marbles

The marble trick is supposed to help “round” out the belly button and/or enlarge it a bit if it is starting to constrict down too much.

Unclear how well this works, but I have had some patients with success.  Don’t make it too big- We don’t have a “shrinking” technique for belly buttons which are too big.

The marble trick:

If you have a small or slit like belly button, you can try the “marble trick.” 

Once healed (likely at least 2-3 weeks out from surgery), you put a marble into the belly button and tape it or hold it down. 

The first time do it for 15 minutes and see how you feel. Is it sore? Irritated?

Make sure the marbles are clean (alcohol or antibacterial soap)

Clean and change it out daily. You can work up to a few hours daily.

What is the thought?  The idea is the marble serves as a kind of stent to help massage the scar, soften it, enlarge the area, and round it out a little.  ? Not sure how much it works, but it’s worth a try.  Just go steal a few of your kid’s marbles of different sizes, and you can gradually upsize.  Just don’t overstretch it.  That you can’t reverse.

Let’s hear it for the girls! 

I love breastfeeding.  We always knew it was good for your heart to snuggle and be close to your baby (awwwww.)  But now science supports it as well.  I know breast feeding doesn’t make the breasts look prettier long term (in the short term it can do wonders though).  I know as a plastic surgeon many of you think we only care about how pretty your breasts are.  And I do care what they look like, but the breasts have a purpose other than looking good in a bikini.

A new study came out in Diabetes  (and was presented by Gunderson’s team on June 6 in New Orleans at the American Diabetes Association’s 69th annual Scientific Sessions meeting).  It was a long term prospective study of 1400 patients.  In it, they looked at the benefit to mom (not babe) of breastfeeding, specifically looking at the “metabolic syndrome” of risk factors which cluster and increase your heart risk.

What increases your risk of heart disease and diabetes?

  • Abdominal obesity (the apple body shape, not pear, especially when the fat is “intraabdominal” behind your belly muscles)
  • high blood pressure
  • cholesterol (low HDL the good one, and high LDL, the bad one)
  • high triglycerides
  •  insulin resistance
  • inflammatory markers
  • a tendency to clot.


They found of these 1400 women, 50% had kids.  They followed them at 7, 10, 15, and 20  years. They found the risk of the “metabolic syndrome” was reduced in women who breastfed.  This risk was reduced further the longer you breastfed.  For those who breastfed over 9 months, the risk went down 56% in those with no gestational diabetes (diabetes while pregnant, a marker for those at risk for diabetes later in life) and 86% for those with gestational diabetes.


They don’t know why. ? Does it increase your good HDL cholesterol?  Lower the abdominal body fat? Or help with the metabolism of blood sugar and lower your insulin levels?  We don’t know. But it was nice to see these results.

So let’s hear it for the girls.

Don’t worry- if they look bad when you are done, I can help you. But a healthy heart- that looks good on everyone.


I just wrote a blog on my website about skin products. Winter is a fantastic time to clean up your skin.  Shorter days, less sun… But many of  those lovely products which help with wrinkles and ridding of pesky pigment in your skin (which while pregnant likely got worse.)… many of those products you cannot use when you are with child or breastfeeding.  Ug!  I was pregnant and/or breastfeeding for 6 years straight.  I get it.  You are sleep deprived; your body has been depleted of every vital nutrient; the hormones wreak havoc on your skin; and then you can’t use stuff to fix it.  That can do a doozy on having lovely skin. (Imagine how it is when you are a plastic surgeon and people expect you should have nice skin.)

So blah blah blah.  I hear I can’t use Retin A (Antioxidant. Makes dermis thicker, realigns collagen, helps skin turn over more), Hydroquinone (Skin bleacher- doesn’t make it white, just gets rid of pigment), Latisse (eyelash enhancer), Botox (wrinkle remover) or do a TCA chemical peel (to resurface the skin- improves fine lines, reduces pore size, and removes superficial pigment).  Let’s be positive, what CAN I do?


When I was in my babymaking and breastfeeding years, I purposefully looked for products which 1. worked (and could prove to me they worked with scientific studies, not the “70% of women thought they saw improvement in the mirror” ) and 2. were baby safe.  What to do?

1. Sunscreen. I know you are tired of hearing about it. I am tired of writing it. But prevention is always the best.  Mechanical blockers (zinc, titanium) block the sun rays and are not chemicals absorbed into the skin.  Thought to be safer for babies.

2. Antioxidants.  Vit C and E products are antioxidants.  They are not miracle workers, so don’t expect any changes overnight.  But with steady use, they help fine wrinkles and pigmentation.  And again, are baby safe if not mixed with other things.  (Some products are mixed with hydroquinone or other things which are not baby safe.)  My favorite brand? Skinceuticals. They were one of the only brands who showed me studies of the skin improvement with histologic biopsies. (oooh aaah. Real science is great to see.)

3. Natural agents against pigment.  Phyto by skinceuticals is one I favor.

I know the list is short, but continue to treat your skin while you are pregnant and breastfeeding.  The healthy “glow” thing is great, but you want to avoid losing as much ground as you can.  When you are done with all the baby stuff, then we can talk about other ways.  So snuggle in with your little one. Winter is here.