Mommy Make Over Part 2 continued from Sept 25th blog

A “Mommy Make Over” usually involves surgery to improve breast shape and volume, abdominal laxity, and liposuction of trunk and thighs. So let’s talk about each one of these areas individually. This blog will focus on breasts.

Has gravity stolen your “power”?

The breasts often have dramatic changes after pregnancy (with or without breast feeding). Where your breasts were once perky and up on your chest, now they rest sadly on your lap. Only 15% of women maintain the same breast volume after childbirth. So there is a good chance, if you are reading this article, you know what a deflating experience this can be. To correct the volume loss, we use breast implants. There are many different breast implant options with two major divisions: Saline filled and silicone gel filled. They can be smooth or textured, round or shaped, positioned in front or behind the pectoralis muscle, and a myriad of projection or style choices. That discussion warrants a blog of it’s own. Implants restore breast volume and produce long lasting upper pole fullness. Though they may seem to have magical powers, the implants cannot overcome the issues of breast laxity. Back in the early 1990’s some authors suggested that you could avoid the scars of a breast lift in “relaxed” breasts by putting larger implants above the muscle. This is a bad idea. What I have noticed is this concept just produces large saggy breasts; it will NOT lift them up.

A discussion of what to do about the ptotic or saggy breast should be separated into two categories, those few who have plenty of volume and are not looking for persistent upper pole fullness and the majority who have deflated to varying degrees. Let me put rumor to rest; your nipple stays attached to your breast and is just moved up…not cut off!

Our first group would be candidates for a breast lift or mastopexy. There are three major incision styles used and their success is dictated by the quality of the breast skin and how low the nipple/areolar complex is on the breast mound. Here are some options: (see diagram below)

1) A Benelli (donut or concentric) mastopexy employs an only an incision around the areola. The most a nipple can be moved up on the breast is around 2 centimeters and without an implant produces a flattened breast mound.

2) A Circumvertical (lollipop or vertical) can move the nipple higher and tightens the lower pole sagging so that your breast will not be sitting on your upper abdomen any longer! The scar is longer but you get a perkier more spout like breast. Some of the lower pole soft tissues can be tucked up under the upper pole and nipple to produce temporary upper pole fullness. There are many variations of the procedure. I prefer the vertical because the breast can be narrowed and it actually moves up on the chest wall. Patients often try to show me where they want their breasts by grasping them and holding them up higher. “ I want them back up here!” Sound familiar?

3) A Wise pattern mastopexy has the Circumvertical scars plus a scar along the breast fold and is utilized when there is more laxity than can be corrected with the Circumvertical approach. This technique has the longest total length scar.

Our second group would be better served with an augmentation mastopexy (lift and implant) to restore volume and correct breast laxity. This is usually done simultaneously or more uncommonly in two separate surgeries.

· The first hurdle is answering the question whether or not you “need” a lift. Most often if you have to ask, then you would benefit from a lift but this issue can best be resolved during an evaluation by a plastic surgeon.
· The next hurdle is to determine how much volume you want. There are lots of ways to help a patient and their plastic surgeon determine volume goals. Some bring in photos. Some use computer generated programs. I use a specially designed sizing bra, which has pockets to hold various breast forms, to simulate the shape for any given volume. You may bring in a special outfit or shirt and see what a range of different volumes appear in your wardrobe. There is no absolute way to insure meeting every patient’s expectations but this technique helps determine generally what our patients want.

Now for the fun surgical part!
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Armed with the above information and breast dimensions, implants and sizers can be ordered for surgery. After creating symmetric submuscular pockets, I insert various sizers, the excess skin tailor tacked and our patient is placed in an upright position. I make the final implant choice based on what the breasts look like with different sizers. After the selected implants are inserted using the” no touch technique”, the implant pocket is closed and the patient us again put back in an upright sitting position. Final tailor tacking is done and the scar pattern is based the degree of tissue laxity as discussed above for group one. Basically I put the implant in for volume and move the nipple onto the most projecting portion of the breast mound, and remove the excess tissue. Once the best shape has been achieved the edges closed and “Viola”! You’ve got the power back!

My next blog will address the next part of the Mommy Make Over:

Liposuction of the trunk and thighs.