| “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.
BREASTS: 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 sequelae 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)
TUMMY:
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. In the non-pregnant tummy, the rectus
muscles may give the “six pack” look.
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?
Liposuction: 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 tucks (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.
LABIA: (labiaplasty)
Recently, a lot of interest has been shown in labial reduction
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. 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. 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 mastopexy
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.
Should you have any specific questions regarding the above, please
feel free to email me All emails are read
only by me, the doctor, and almost all will be answered personally
within 48 hours.
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