May 2010


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.