Abstract
In current society, there is an increasing demand for more product, delivered quickly and efficiently. Today’s plastic surgery demand is no different. Patients desire a total body improvement in a single operation. Modern surgical techniques, together with advanced anesthetic technology, make it possible to perform combined procedures safely. The term “mommy makeover” is used to refer to a single operation composed of multiple procedures that addresses different areas of the body simultaneously. This is generally used to reverse the common changes associated with pregnancies, but is also used to improve changes associated with aging and weight fluctuations. This most commonly used procedures include abdominoplasty, liposuction, and cosmetic breast surgery, but will vary from patient to patient. This chapter will discuss what most commonly constitutes a “mommy makeover”—how to choose appropriate patients and procedure combinations, how to modify your techniques when combining procedures, and how to perform combined surgeries efficiently, thereby minimizing operative time and reducing surgical risk.
79 Mommy Makeover Finesse
Key Points
“Mommy makeover” refers to a combination of procedures, performed during a single operation, to reverse commons signs of aging and pregnancies.
Advances in surgical and anesthesia techniques have enabled us to do combination surgery more safely.
The specific combinations are unique and customized to each patient.
Proper combination surgery requires that the surgeon consider each procedure individually and also how each relates to and affects the other.
79.1 Defining a “Mommy Makeover”
Single operation consisting of multiple procedures, each designed to address specific areas of the body.
Most commonly used when referring to surgery to reverse effects of pregnancy.
The term is a misnomer, and patients need not be mothers or have had prior pregnancies.
Also used to refer to combined surgery to correct changes from normal aging process, congenital abnormalities, or fluctuations in weight.
79.2 Most Common Procedures
Breast procedures:
Augmentation mammoplasty, mastopexy, augmentation, mastopexy, reduction mammoplasty.
Abdominal procedures:
Abdominoplasty, extended abdominoplasty, mini abdominoplasty.
Liposuction.
Buttock augmentation.
May include virtually any procedure since each operation is customized for individual patients.
Circumferential approach will offer the most dramatic improvement.
Most commonly involves procedures for the breast and body, although facial procedures are not excluded.
79.3 Preoperative Considerations
79.3.1 Patient Selection
Surgeries tend to be longer so patient selection is critical.
Healthy patients with appropriate medical clearance.
Complete blood count (CBC), prothrombin time (PT)/partial thromboplastin time (PTT), basic metabolic panel, electrocardiogram (ECG), chest X-ray (CXR) (if over 50 years old), physical examination, and written medical clearance by primary medical doctor or any relevant specialists.
Hemoglobin >12.5 g/dL.
Optimization of any pre-existing medical issues.
Nicotine cessation for a minimum of 4 weeks prior to and 8 weeks after surgery.
Patients with realistic expectations who understand that combination procedures require longer recovery periods and higher revision rates.
No immediate plans for pregnancy.
Minimum of 9 months post-partum.
79.3.2 Selecting Procedure Combinations
Combination should be selected to maximize patient improvement and minimize operative time, while understanding how combinations affect healing and results.
Anticipated postoperative pain and required time off from work or away from family responsibilities are a consideration and should be discussed with patients.
It is best to address the areas that bother the patient the most, knowing that it is not always possible to safely address all the areas in a single operation.
Anterior-only combinations—abdominoplasty, breast surgery, and anterior/lateral liposuction:
Allows for ease in operative positioning and more rapid operative time.
Positioning during recovery period will be supine.
May not offer maximal improvement since posterior defects are not addressed.
Addition of posterior procedures—posterior liposuction, skin removal, and buttock contouring:
Will require position changes in the operating room with additional operative time.
Positioning during recovery period will be supine or lateral since prone positioning can adversely affect results of abdominoplasty or breast surgery.
Increased risk of dependent seroma formation after posterior liposuction and placement of posterior drain may be indicated.
When buttock contouring with fat grafting is performed, there will be increased risk of fat resorption from pressure of supine positioning during recovery.
79.3.3 Surgical Markings
Surgical markings are made as per usual, with some specific considerations.
When combining breast surgery with an abdominoplasty, you must consider the inferior stretch on the inframammary fold (IMF) (Fig. 79.1).
Breast markings must be adjusted to account for inferior IMF displacement and should be made while the abdomen skin is “on-stretch.”
Failure to anticipate IMF displacement will result in visible scars on the superior abdominal wall that would normally be concealed within the IMF.
IMF displacement will alter the nipple to IMF distances which is important during breast lift and reduction procedures.
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