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.

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 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.

Yay.

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.

It is recommended you breastfeed exclusively for 6 months.  I breastfed all of my children.  Particularly with the dangers in the world of swine flu and other diseases, it is one of the best gifts you can give your child.

Breastfeeding can take a toll on your breasts.  So here are some recommendations:

1. Alternate breasts.  Everyone has one side which is easier to feed on, produces more milk, the baby likes it better, etc etc. Breasts are not symmetric.  They are different sizes and different producers.  Try to use both breasts evenly.  Use a timer and switch to the other side.  Personally, I tried to feed from both breasts with each feed.  When I have patients who exclusively breastfeed on one side, there is a marked difference between their breasts at the end.  The key to breasts is symmetry.  Whatever you do, you want your breasts to look as alike as they can.

2. Support.  Breasts are not a muscle. The infamous ”we must, we must, we must increase our bust” exercises don’t work.  The pectoral muscle lies beneath the breast tissue.  The breast itself is composed of breast tissue, ligaments, and fat.  When the tissue has stretched, there is no way to “firm” it up again with exercises, creams, or lasers.  So wear a bra.  Make sure it fits well and is really supporting you.  Sleep in the bra.  To see if the bra is giving good support, jump up and down in front of the mirror and see how well you are supported.  Everyone has seen a woman jogging who does not have enough support.  A good bra has a defined size, 2-3 rows of hooks in the back, and adjustable straps to transfer the weight of the breast to the shoulder.