March 2011


Abdominoplasties come in all shapes and sizes, just like the women who need them.  This blog will be a glossary of some of the common terms.  From biggest surgery to smallest:

Full abdominoplasty.  Also called Tummy tuck. Two scars: one incision from about hip to hip and one around the belly button.  The muscles are tightened and usually all of the skin between the pubic area and belly button is removed. This can be combined with other procedures like liposuction of the flanks.  Cannot be combined with liposuction of the belly itself.  If you have hanging skin, volumes of loose skin, or loose skin above the belly button, this may be what you need.

Mini abdominoplasty.  Also called a mini tummy tuck.  The incision for a mini can be placed as low as you want to go.  The scar length can vary– from short like a C-section to longer from hip to hip.  The longer the scar, the more skin is removed.  (and most are not the short C-section kind.  Sorry.) Does not have an incision at the belly button. (Good for bikinis and low rider jeans) Does minimal to no tightening of the skin above the belly button.  It does tighten the skin of the lower belly. You can combine with liposuction of anywhere you want.  You can also combine with tightening of the muscle, though it can be difficult to reach the upper muscle near the ribcage if you are long waisted.

Floating belly button.  This is not a common surgery.  It involves no scar on the skin of the belly button, just one in the lower abdomen.  Your belly button is like a mushroom.  During a normal tummy tuck the belly button does not move- the skin does.  In this surgery, the stalk of the belly button is cut, and the belly button floats down toward the pubic area attached only to the skin.  This allows tightening of the upper abdomen and lower abdomen skin.  The issue is it lowers the position of the belly button, so it is only good for those with high belly buttons to begin with, and the belly button is no longer connected to the stalk.  If you ever need a laproscopic procedure, they cannot use the port through the belly button as this connection is gone. 

Muscle tightening only.  This is for the women who have good skin tone, no fat, but have loosened muscles after babies. (When you aren’t sucking it in you look 5 months pregnant, and when you suck it in you go FLAT.)  A lot of my Bay Area women fall into this category.  The skin incision can be short when you do this.  NOTE:  If when you suck in your belly the skin hangs and is wrinkled, then you likely need some form of skin tightening.  The more skin tightening, the longer the scar.  See mini tummy tuck description above.

The hybrid adominoplasty is a trademarked name of a procedure done by Dr. Moelleken from Southern California.  It is most like the muscle tightening only procedure listed above.

I am a mom.  I gained weight with pregnancy.  How much is “me” and how much is my new baby?  When I gave birth to my first child, I couldn’t stop thinking about it.  As much as I did not want to give birth to a 30 pound baby (OUCH), somewhere lurking in my mind, I thought, “of course this baby must weigh 30 pounds!”  So in my little dreamworld, I thought I would painlessly deliver my 30 pound baby and leave the hospital zipped up in my favorite pre-pregnancy jeans, back to my normal little self.

ha ha.

Most babies don’t weigh 20-40 p0unds, and no one tells you the dirty little secret that those maternity clothes should be called maternity and mother-with-newborn-can’t-wear-normal-clothes-yet clothes.  Most of us take months to get smaller.  When we gain weight with pregnancy where is it?  Is it water weight? Fat? Blood volume?  Why do some lose it so quickly and others don’t?

When you gain weight with pregnancy, some of it is clearly the weight of the baby.  I have researched many sources, and the consensus of a typical pregnancy is:

Baby – 7½ pounds
Enlargement of uterus – 2 pounds
Placenta – 1½ pounds
Amniotic fluid – 2 pounds
Breast enlargement – 2 pounds
Extra blood and fluid volume – 8 pounds
Extra fat stores – 7 pounds
Total – 30 pounds

If you are gaining more, then the question comes, which of these is it?  Babies, placentas, amniotic fluid, and breasts likely aren’t going to be a big contributor.  So when you see women who really balloon up, the likely cause is extra fluid or extra fat.  The women who lose a ton of weight in the first week likely are those who carried a lot of extra fluid, and lose it right after birth.  The others… well those are women who likely have extra fat.  This is much harder to lose, and a common reason why I see women plateau at a higher weight than their prepregnancy weight.

So look at the blogs on the guidelines of how much weight to gain during pregnancy.  For a normal BMI woman with a healthy pregnancy,  you should gain 25-35 pounds.

wish I had a crystal ball.

Every person is different with how their breasts change with pregnancy. Some barely look different, some go up 3 cup sizes.

Breastfeeding adds another layer of change. Are you a producer? Do you favor one side? How big do you get? How long do you breastfeed for?  If you had surgery with an incision at the nipple areola, your milk production may be affected.  I have many blogs on breast milk production after breast surgery.

Each pregnancy is different. As for the droop, it depends on your skin tone, how many pregnancies, how old you are, what your size changes are, and the above.  Keep your fingers crossed.

Advice?
1. SUPPORT SUPPORT SUPPORT. Sleep in a bra. Wear it 24 hours a day.  Wear a good one which looks like Fort Knox.
2. When breastfeeding, alternate (don’t favor one side).  See other tips on my blog.
3. If you see any kind of infection, mastitis, rash, etc, JUMP ON IT EARLY.  Most implants are submuscular, so there is a nice muscle between your implant and the breast.  Most implants have formed a capsule, which protects your implant from your breast.  What you don’t want though is an issue with your breast causing a breast implant infection.  It is rare… but if you are worried about any breast redness, tenderness, or discharge, see a doctor sooner as opposed to later.

And remember to focus on the big picture! CONGRATULATIONS!  Most implants do just fine with pregnancy.