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Going under for the big operation

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Are you a proud mama desperate to get your pre-pregnancy body back? Have you kicked major butt in the gym, only to find that the curvy MILF shape of your dreams is still, well, a dream? Have you spent hours studying the seemingly flawless frames on your IG timeline and wishing that you could look at least a little more like that?

You’re far from alone, as the American Society for Aesthetic Plastic Surgery reports that Americans spent over $15 billion dollars on cosmetic procedures in 2016, up 11% from the year before.

What were the most popular procedures? Liposuction, tummy tucks and breast augmentation, which are often performed as part of a “mommy makeover,” the nickname given to a combination of two or more of those procedures when done after a patient has given birth.

Plastic surgery can improve the quality of life and self-image of a patient who is in the proper emotional and physical health to make such a drastic decision. For anyone who may be considering having a little post-baby ‘work’ done, it’s extremely important to enter the world of body modification prepared for both the best and worse case scenarios.

Dr. Darren Smith is a New York City-based surgeon who was trained at some of the nation’s most prestigious institutions to perform both craniofacial and aesthetic plastic surgeries (in plainer terms, he work on faces and bodies.) We caught up with Dr. Smith, known for his expertise in post-pregnancy cosmetic procedures, to learn more about what a woman should know before going under the knife.

HB: What does a ‘mommy makeover’ consist of?

Dr. Smith: Pregnancy affects two areas the most, which are the breasts and the abdomen. The phrase ‘mommy makeover’ refers to primarily any procedures of the breasts and the abdomen that might help to return it back to the pre-pregnancy state.

The most common abdominal procedure done as part of a ‘Mommy Makeover’ is an abdominoplasty, better known as a ‘tummy tuck.’ The reason for that is that during pregnancy the uterus expands and then abdomen expands to make room for the expanding uterus.

[This procedure] treats the different layers of the abdomen. It gets rid of extra skin and sews the ‘six-pack’ muscles back together. There’s often a component of liposuction involved with abdominoplasty as well to just help fine-tune the abdominal contour. There are different kinds of abdominoplasty for different kinds of issues. In fact, some women don’t need an abdominoplasty at all but would benefit just from a little liposuction to re-contour things. There’s a whole range of things that someone might want to do in terms of restoring the appearance of their abdomen.

During pregnancy, the breasts often enlarge. After delivery, the breasts may lose volume. That is accentuated further by breast-feeding. The breasts lose volume in a specific way. That is, they actually can have a deflated appearance, especially in the upper pole or the top half of the breast. The nipple areola complex actually can sag or become lower. There are also [less common] cases where the breasts enlarge and then don’t deflate after pregnancy and women are left with breasts that are much larger than they’re comfortable with.

Again, just when we’re talking about changes of the abdomen and the procedures that someone might choose to have, it’s based on an individualized evaluation and approach for what the particular issue might be. For example, for the classic post-pregnancy breast change, the deflated appearance, the sagging nipple areola complex, we might talk about something like a breast lift [a mastopexy] if the woman just wants to have her breast shape restored.

If she’s looking to also have some of the volume restored that she’s lost, we might talk about a breast augmentation or breast implant. If both of those things had happened, if there’s both a decrease in volume and unsatisfactory change in shape after pregnancy, you may consider a simultaneous breast lift and breast augmentation.

HB: What’s the most commonly requested breast procedure, in your experience? Are most women going for just the lift, or the lift and the augmentation?

DS:  Usually after pregnancy, it’s a lift and augmentation. In someone who only has a small amount of sagging, for lack of a better word, you can often fix the problem just with an implant. If you’re putting in a large enough implant, you will get some lift out of that.

HB: Who would be a good candidate for tummy tuck and/or liposuction? Who wouldn’t be a great candidate?

DS: In terms of good candidates for abdominoplasty, it depends on an analysis of what we call the “treatable” layers of the abdomen. Those are skin, fat, and muscle. In general, a woman who doesn’t have a lot of skin excess or skin laxity [loose skin] but just has some extra fat that she’s like to get rid of, that’s a fantastic liposuction candidate.

For someone who has a lot of skin laxity or skin excess, that’s somebody who would really benefit from the abdominoplasty where that skin can actually be removed. The other kind of person that would benefit from an abdominoplasty much more than liposuction is someone that has a lower abdominal bulge [often called a ‘pouch’ or ‘pooch.’]

HB: How long should mothers wait before having plastic surgery?

Dr. Smith: In terms of timing of these procedures after pregnancy, childbirth is obviously a very big deal. There are a lot of psychosocial factors to consider. You have to make sure that you are ready as a patient to go through a change. Although it’s a positive change, it’s something you have to be ready to do for yourself. That’s the most important thing. There’s also the physiological changes that go on. It’s almost best to do any kind of body contouring operation when your body shape is relatively stable.

If someone is in the process of losing a lot of weight, for example, they should wait until their weight is stable for a number of months before they have any operations. Doctors need to know what we’re operating on and that we can reach an excellent outcome that will last. The same is true after pregnancy. After pregnancy, the body goes through changes to get itself as close as possible to the pre-pregnancy state. What we usually recommend to patients is that they wait three to six months after either delivery or the conclusion of breast-feeding before they have any of these operations.

HB: What about women who may have more children in the future, can they have one of these procedures?

Dr. Smith: If you really want to change your abdominal shape, you can almost always achieve some improvement with liposuction alone, but if there’s skin laxity, you can only change that with abdominoplasty. With realistic expectations, if a patient is going to be happy just reducing their bulk but not necessarily reducing extra skin, I think it’s fine to have liposuction if you’re planning to have more children.

I would not recommend someone have a full abdominoplasty if they’re planning on having more children. Not saying that this is dangerous, because the abdominal wall can just stretch out again to make room for the uterus if she gets pregnant. However, you’re going to just undo what was done.

HB: Many women are going to the Dominican Republic and other parts of the world to have these procedures done there at a lower cost than they could with most US doctors. What are the potential risks associated with traveling for surgery?

Dr. Smith: Plastic surgery, when practiced properly and according to strict safety standards, is a very safe experience. The advantage of having plastic surgery done in the United States in an accredited facility is that you know that all the proper precautions are being taken. Examples of this are things as simple as making sure instruments are properly sterilized and that all precautions are taken to avoid blood clots. If they’re not, you can have potentially life-threatening infections and/or disfiguring results.

HB: What are some of the risks women should discuss with their surgeons regardless of how reputable they may be?

Dr. Smith: Good doctors always talk to patients to make sure that they can participate in a surgery with informed consent. We talk about infection risk, which can occur even in the best of circumstances with perfectly maintained instruments and operating rooms. They are very unlikely and can usually be treated just with some antibiotic pills when they do occur. We also warn them about unexpected and/or excessive post-surgery bleeding, which should be treated immediately. It’s unlikely and something that, luckily, I’ve never had happen to one of my patients, but doesn’t mean that it’s impossible.

Patients must also be aware of the possibility of a pulmonary embolism, which is a blood clot that usually starts in the legs and travels through the bloodstream to the lungs. That’s something that can be very dangerous. Again, it’s usually treatable in a hospital setting with a blood thinner.

Again, although all these things are very unlikely [with a competent surgeon in a safe facility], the reason they’re unlikely is because a very specific set of precautions is taken. You can really only be sure that these precautions are being taken when you’re having your surgery done in a very carefully monitored situation. You expose yourself to much higher risk for all of these things and others when you go to nonaccredited facilities.

HB: What’s the recovery time for these procedures?

Dr. Smith: When we talk about the recovery time from an abdominoplasty, we ask people to take about two weeks off of work. Sometimes they’ll pleasantly surprise us and be back to work a little sooner than that. We’d rather plan for the longer recovery. Positive surprises are better than negative surprises. The first week you’re slowed down, you’re not doing much of anything. We want you walking around a little bit, but certainly no heavy lifting, no real household chores. Just let your loved ones take care of you. That’s for the first week.

For the second week, you’re starting to get up and around a little bit more. By the time two weeks is over, you’re back to work. We say that usually by five or six weeks, it’s almost like you haven’t had surgery. You can go back to the gym. You can do pretty much whatever you want. Between the two-week mark and the six-week mark, you’re slowly ramping up back to normal.

HB: What happens if you gain weight after having liposuction?

Dr. Smith: I’m glad you asked that. Understand that it’s very important to understand the way that fat metabolism works. From childhood, you have a predefined number of fat cells in your body. You don’t make more. You don’t get rid of fat cells. You can almost think of them as expandable storage boxes. If you’re eating more calories than you can burn, your fat cells grow. You don’t make more fat cells. Alternatively, if you burn more calories than you’re taking in and you’re losing weight, you’re not actually losing fat cells. Your fat cells are getting smaller as the fat leaves them.

When we do liposuction, we are actually physically removing fat cells, which means that if you do after your surgery gain significant weight, you will not gain as much of it back in the area that you had liposuction.

HB: What is the ballpark price for the various procedures that you described?

Dr. Smith: For liposuction, you’re looking few thousand dollars per area [of the body.] For abdominoplasty, patients usually spend between nine and fifteen thousand dollars and breast procedures are around the same price range. All of this will depend on the exact amount and type of work a patient requires.

To learn more about Dr. Smith’s work, check out his website:


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