“Having a child changes your life forever”
Every first time expectant mother is made acutely aware of this fact on an almost daily basis. What perhaps is made less apparent is that having a child will change your body forever! I remain in awe at the miracle that is pregnancy and childbirth, but have also come to see a number of women in my practice whose bodies have changed substantially as a result of this phenomenon. The main areas of concern are the breasts, tummy, and to a lesser extent, the labia minora.
A non pregnant breast is composed of skin on the outside, and a mixture of fatty tissue and fibrous tissue (breast tissue) on the inside. Under the hormonal control of pregnancy, the breast tissue component increases (and hence the increase in breast size), in preparation for breast feeding. During breast feeding, the lobules increase in size, and start producing milk, and the breast may occasionally become engorged with milk, if not drained by the baby or expressing the milk. In addition, the nipples become larger; the areola complex may darken in colour and also become larger.
On cessation of breast feeding, the “milk producing” tissue involutes (gets smaller) and there is an attempt by the body to return things back to “normal”. This process takes several months.
However, in many patients, the following may persist:
1. Breasts remain very soft
2. Breasts that appear “empty” / volume loss / shrinkage
3. Droopiness and sagging of the breast
4. The areola and/or nipples may remain relatively large
While it is impossible to regain the firmness that may have preceded a pregnancy and breast feeding, there are some surgical alternatives to the other problems, notably:
Breast augmentation: to replace lost volume
Breast lift and / or reduction:to lift, re-arrange the content and better shape the breast.
Nipple and / or areola reduction (occasionally combined with the above surgeries)
It’s no surprise that the tummy is the area most affected by a pregnancy (and more so by a multiple pregnancy). As pregnancy progresses, and again under hormonal control, the tummy expands to accommodate the enlarging womb. This involves all layers, so that more skin in produced, and the tummy muscles (rectus abdominus muscles) relax and separate. Many women have caesarian sections, and this also contributes to the muscle damage of the abdominal wall, and leaves one with a scar in the lower abdomen.
After pregnancy, one may be left with the following change in the tummy contour:
- The skin may not retract to its former state, and stretch marks may be present (stretch marks represent tears in the skin, and cannot be “repaired” by creams, laser or surgery). If a caesarian section has been performed a scar will be present in the lower abdomen, and occasionally, there may be some puckering in this area such that a small fold of skin “hangs over” the scar.
- The belly button (umbilicus) may be distorted, shifted left or right of the midline, and may contain a small hernia.
- The rectus muscles remain separated leaving a groove in the midline, and occasionally a bulging lower abdomen. (This is easy to feel for yourself: – lie down on a bed, do a straight leg raise with both legs about 6 inches off the bed, and feel for a groove in the midline, above or below the belly button) This is known as “divarification of the rectus muscles” and although tummy exercises will strengthen the muscles a lot, it is impossible to get the muscles back together in the midline without surgery.
- Hernias may be present.
- Stubborn fatty deposits may persist
So… What if anything, can be done surgically to improve the tummy area?
This can be done to better contour stubborn localized fatty deposits, but only provided the skin tone is good (no stretch marks) and the muscle tone is good, with little separation. Read more about liposuction.
TUMMY TUCK / ABDOMINOPLASTY
There are a number of variations to this surgery, ranging from a mini tummy tuck to a full tummy tuck. These surgeries may combine liposuction together with removal of some excess skin, and (most importantly) tightening of the rectus muscles in the midline. Read more about tummy tucks.
Recently, a lot of interest has been shown in labial reduction / labiaplasty surgery. This is a surgery designed to decrease the size and protrusion of the inner labia. Although there is wide individual variation in the size and shape of the inner labia, some women find it cosmetically troublesome if the inner labia protrude past the outer labia. Large inner labia may result from pregnancy and natural childbirth, but there are a number of other causes unrelated to pregnancy.
Whilst previously the solution to this “problem” was simply removing the excess tissue by trimming off an edge, I prefer to do a more elegant operation that minimizes the scarring, and largely preserves the natural outer edge of the inner labia. Experience is the key to the best possble outcome. The surgery can safely be done as a day case under local anaesthetic with light sedation, is well tolerated, and the patients are generally thrilled with the results. I have done over 300 to date. Read more on labiaplasty and labial reduction.
So… there is hope for those women who, after childbirth, are left wondering what happened to their bodies. Surgery, however, is not an alternative to possible weight loss and exercise, which should be the primary way to get in shape after childbirth. Surgery is principally designed to contour those areas that cannot, by themselves, be assisted by exercise, and include adding volume to deflated breasts with breast implant surgery, lifting sagging breast tissue with mastoplexy or breast reduction, removing excess tummy skin (with or without stretch marks) and tightening the rectus muscles in the midline with tummy tuck surgery, and performing a labiaplasty if this is an area of concern. A minimum of 6 months after cessation of breast feeding (ideally a year or longer) should pass before any surgery is entertained, and ideally one’s family should be complete before tummy tuck surgery is undertaken.