During the past 10 years, an extraordinary social phenomenon has been increasing in plastic surgeons’ offices across the country. Middle-aged mothers are having their sagging breasts enhanced, their loose abdomens tightened and their excess waist fat liposuctioned away.
Plastic surgeons often describe this combination of procedures as the “mommy makeover,” a concept and phrase that resonate with women who have completed their childbearing years. The individual procedures have long been provided, and the technology is not new. The standard techniques have been refined, however, so they can be performed in one or two operative sessions.
Fifteen years ago, combining and integrating body-contouring operations was a radical approach that I introduced as the Total Body Lift.1 But what was rare then has become commonplace. I have devoted the past seven years to improving body-contouring outcomes for all our patients through better patient selection and preparation, a more artistic approach with new techniques and technology, and improvements in post-operative care.2
Today’s savvy moms are aware that several procedures can be safely performed at once. Most commonly these operations are breast augmentation with implants, mastopexy, abdominoplasty and liposuction. (Examples of several of the author’s cases are shown in figures 1, 2 and 3.)
Mommy Makeover versus Total Body Lift
Predating the mommy makeover era, I was implementing new operations and their combinations for the rehabilitation of the massive-weight-loss patient.3 My thesis was that comprehensive and coordinated aesthetic reconstruction after major skin laxity and contour changes can and should be performed in as few stages as safely possible to boost patient satisfaction and self-esteem. For example, the patient may appreciate her abdominoplasty but still have low esteem and not wear revealing clothing if she considers her thighs unacceptable.
Single-stage Total Body Lift is best performed on those who are physically and mentally fit, under the age of 50, and highly motivated. After massive weight loss, they are willing to accept a 65 percent rate of minor wound-healing complications.4 Since 2008, however, improved patient selection, safety measures and techniques have reduced that rate. Furthermore, the post-pregnancy candidate is much healthier and has less tissue damage than the massive-weight-loss patient. Additionally, the skin and contour change after pregnancy is not nearly as severe; hence the operations are shorter and the tolerance for complications is less. While eight hours of operative time is common for the massive-weight-loss patient, we rarely exceed four in the post-pregnancy patient.
There is no stereotypical mommy makeover patient. For the most part, I have found these women unwilling to accept what they witnessed in their own mothers.
We most often perform isolated breast augmentation with or without mastopexy and isolated abdominoplasty. However, many multiparous mothers want correction of their entire torso. If they are healthy, fit, young, motivated and not obese, we perform a single stage. (See a video of a single-stage mommy makeover, including a breast lift, abdominoplasty and liposuction of the flanks, at hurwitzcenter.com/body-contouring.)
Encouraging Safety Data
Hester et al. first reported favorably on combining abdominoplasty with intra-abdominal, pelvic or other aesthetic procedures, noting comparable complication rates and citing only obesity as a risk factor for unfavorable outcomes.5 Stevens et al. report no increase in complications when comparing isolated abdominoplasty with abdominoplasty combined with breast surgery or facial rejuvenation.6 Increased systemic risks, such as cardiac, pulmonary and anesthesia-related complications, are important to consider but do not appear to be clinically significant. In general, in our experience, performing combined aesthetic procedures on anatomically distinct areas such as the abdomen and the breasts does not lead to an increase in systemic morbidity when proper safety measures are instituted.
Operative duration is the single variable that is readily quantified and applicable across studies investigating the safety of combining multiple procedures. The precise significance of this metric is not completely understood: It is not clear from an outcomes standpoint whether one four-hour procedure is preferable to two procedures lasting two hours each. However, we do know that prolonged exposure to general anesthesia and other potentially deleterious intraoperative conditions (e.g., blood loss, hypotension, hypothermia and exposure to infection) interfere with the body’s maintenance of physiologic homeostasis. Every effort must be made to maintain homeostasis during anesthesia, regardless of the length of the procedure.
In addition, several “red flag” patient characteristics emerged from our experience that apply to combining abdominoplasty with any procedure. Pulmonary conditions, history of or propensity for venous thromboembolism, cardiac insufficiency, peripheral vascular disease, hypertension, obesity, bleeding diathesis, smoking, exposure to secondhand smoke, and diseases affecting the microcirculation (e.g., diabetes, lupus and chronic fatigue syndrome) should give the surgeon pause before combined abdominoplasty and breast surgery is undertaken.3
The Hurwitz Center for Plastic Surgery is located at 3109 Forbes Ave., Suite 500, in Pittsburgh. Complimentary parking is provided. Visit hurwitzcenter.com for more information. To receive 10 complimentary copies of Total Body Lift, a hardbound, 192-page patient education book for the office, or to refer a patient, which waives the consultation fee, call 412-802-6100.
- Hurwitz, DJ, Single Stage Total Body Lift after Massive Weight Loss, Ann of Plast Surg, 52:5;435-441, 2004
- Hurwitz DJ, Aesthetic Refinements in Body Contouring Surgery: the Torso, Plast Reconstr Surg, 2014; 134;6, 1185-1195.
- Matarasso, A; Smith, DM. Combined Breast Surgery and Abdominoplasty: Strategies for Success, Plast Reconstr Surg, 2015,135:5:849-860
- Hurwitz, DJ, Agha-Mohammadi S, Ota K, Unadkat J, A Clinical Review of Total Body Lift, Aesthet Surg J 28:3; 294-304, 2008.
- Hester TR Jr, Baird W, Bostwick J III, Nahai F, Cukic J. Abdominoplasty combined with other major surgical procedures: Safe or sorry? Plast Reconstr Surg 1989;83:997–1004
- Stevens WG, Repta R, Pacella SJ, et al. Safe and consistent outcomes of successfully combining breast surgery and abdominoplasty: An update. Aesthet Surg J 2009;29:129–134