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Q: Doctor, we have heard recently and seen on some websites that a new type of surgery called mommy make-over is available to improve the figure of young mums. Can you shed some light on this?
Ans: Mummy or Mommy make-over is a new concept and not a new surgery. This concept evolved over a period of time. While dealing with women who come for plastic surgery following pregnancy, one hears the same story repeatedly. The women invariably say that they had a fine figure before pregnancy but after childbirth, they do not recongnize themselves. They are often at a loss to understand why this happened and are quite often depressed. They also are dismayed to see that exercise does not seeem to work, in fact for many nothing seemed to work until they came for plastic surgery.

This state of affairs can be changed. Plastic surgeons like myself realized that by combining modern powerful and safe plastic surgery techniques with fitness regimes, one can reverse or undo many of the adverse effects of pregnancy and resotre her body to pre-pregnant form. New reaearch has also identified that not all fat is the same;there are exercise responsive and exercise non-responsive fat compartments. The latter do not go away easily. There are many latent genetically determined changes in the body that get unmasked only after pregnancy, i.e the woman would have had a ‘normal’ figure before but during pregnancy something ‘weird’ happens to their body shape. This type of extreme change happens in a few women, so far it is difficult to predict.

Q: Why has this concept evolved now? What are the unwelcome effects of pregnancy?
Ans: To answer the first question first. Modern lifestyle is a high risk lifestyle. Sedentariness has become the default mode, food is more calorie dense and women are getting their first pregnancies rather late in life. This last factor has increased the use of fertility boosting drugs and sometimes enforced (medically advised) rest to preserve a high risk pregnancy. Lack of knowledge also has prompted women to treat a normal pregnancy as a medical condition, leading to a decline in exercise and increase in ‘rest’. All this invariably leads to excess weight gain – the chief culprit.

Pregnancy and child-bearing are some of the best moments of a woman’s life. A whole set of well evolved biological events happen during pregnancy to prepare the woman for childbirth. The pregnancy hoemones orchestrate various changes in the skin, breasts and nipples, abdomen, hips&thighs with a view to store enough reserve energy on the body to protect the mother from the demands of pregnancy and to equip her for the nursing [lactation] to follow. Then there are changes in the genital area due to the stretching of childbirth. These changes permanently alter a woman’s body. Although many of these changes reverse with time in most women, some are not so lucky. If the woman chose not to breast feed, then the excess fat deposited on her body may decide to stay on!. Further, even with breast-feeding, some women continue to hold that excess baggage or actually pile on more. In addition, some women get extensive and prominent stretch marks. Soon the woman is fighting a losing batle to re-gain her former figure and shape.

Q: Are these changes un-avoidable? Can she do anything to minimise the impact?
Ans: It is common observation to see that some women return back to their pre-pregnancy weight and figure effortlessly while others chage permanently. We do not yet have all the answers to this paradox. What is known however, is that the racial type, genetics and eating/exercise habits have an important role. Of these eating and exercise alone are under her control. In traditional societies where daily chores give ample exercises and the general diet is not calorie dense, excessie weight gain is not a problem. In sedentary societies with calorie dense diet, the risk of excess weight gain is very high.

In a nutshell, if the woman watches what she eats [quality and quantity] and exercises regulary, she can avoid such a catastrophe.

Q: What do you do in mommy-makeover procedures? which areas are addressed?
Ans: I start with taking a detailed history of her pregnancy to gain insight into why the unwanted changes happened. We also go into the details of labor, delivery etc to know if there was any unusual difficulty. Enquiry is also made into her pre-pregnant weight, figure and state of shape. Questions are then directed at current difficulties, areas of concern and goals for improvement.

Following this i examine all the areas listed above to arrive at an analysis of the various problems in terms of structural defects, energy/calorie imbalance and fitness requirements. The genital area is also examined, if necessary, with a gynecologist to understand the structural problems there. There could be tears, poorly healed episiotomy incisions, lack of tone, fat loss, downward descent etc to name a few.

A plan is then made regarding three aspects. 1) Energy issues dealing with calorie intake and expenditure. This means restricted dietary intake and exercises to burn off excess calories. A fitness instructor may be needed for those women who have poor knowledge base on exercise issues. 2) Musle toning: This deals with strengtheing of muslces and toning the body;again by working with a fitness instructor and using resistance exercises/weights/calisthenics/yoga/pilates etc 3) Structural issues and beauty enhancements. Here I clearly identify for the woman the structural changes that can only be corrected by plastic surgery [not responsive to the above two strategies] AND those areas where plastic surgery can enhance her beauty. Examples include correction of widely separated abdominal muscles, removing abdominal aprons and excess skin, lifting of sagging breasts, adding or resoring lost volume and fullness to breasts, re-sculpting the body to correct dis-proportions between upper and lower body, fat grafting to face, laser treatmetn to improve stretch marks and of course vulvo-vaginal restoration to correct problems in that area.

Combining many such procedures with fitness regimes gives you the total mommy make-over.

Q: Who needs these procedures? How can a woman know if she can benefit ?
Ans: From what I have stated above, it is obvious the unwelcome changes occur mainly in the breasts, abdomen &genital areas. In addition there may be overall body shape problems with or without weight gain. Women who experience such problems can come for a consultation. Not all women need surgery. In many cases, we just advise them to folow steps 1 &2 and review the situation later. Each case is unique. Again it is a personal choice. It requires strong motivation on her part to go through with this transformation but it is good to know that it is available and that it WORKS!

Q: What are the safety concerns?
Ans: Safety is paramount. As these are elective procedures, careful consideration is given to all apsects and to safety. All the individual procedures are tested and safe already. I take care that when combined together, the safety profile is not adversely affected. The likely complications are discussed during consultation as also the measures we adopt to keep complication rates low. Procedures may have to be sequenced if it is unsafe to combine too many operations in one session.