Mommy Makeover: Abdominoplasty | UCLAMDCHAT Webinar

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good morning my name is geography

section I'm a professor in plastic

surgery at UCLA I've been there about 16

years and I do practice in both

reconstructive and cosmetic surgery

mostly concentrating on breast and body

today I want to talk about a sort of a

very popular topic of and it's called a

postpartum makeover and as exciting as

having a family is sometimes the

pregnancy and breastfeeding can cause

some sort of untoward effects on the

body of the young woman and I like to

introduce you some procedures that we do

offer at UCLA to help sort of address

those asymmetries or address those

undesired effects on the body and then

we're going to go right into it and

start out with the first one and that's

a tummy tuck the most popular operation

performed after having sort of two or

three kids

the dominant wall gets stretched the

skin gets stretched and they have women

have stretch marks and lower part of

your abdomen and also the muscles that

are in the middle of the abdominal walls

separate so essentially a woman not able

to perform a sit-up after a pregnancy

and a tummy tuck addresses all those

things I just mentioned so I am at the

the rectus muscle is what I'm talking

about as far as separation in the

midline and we bring it back to to the

middle and that usually decreases waist

size which is a very very popular thing

or it's a very nice effect that you have

that you decrease your waist assets of

pregnancy remove stretch marks from the

lower part of the abdomen mostly below

the belly button

there's a prominence that the belly

button is moved actually we don't move

the belly button nor do we know that we

alter it we leave it in the same

location except we rejuvenate it a

little bit and it requires a two to

three hour procedure under general

anesthesia with an overnight stay the

only downside to it is there is a

drainage tube that the

the young lady goes home with for about

seven to ten days and we take it out in

the office usually driving driving can

happen in about two weeks and usually I

allow people to exercise in about six

weeks and one thing that women will

notice is they'll be able to do sit up

then which they couldn't do before and

it actually a lot of women post partum

women complain about bloating when they

eat that also is resolved by the tummy

tuck and then I usually don't allow

weightlifting more than 15 pounds for

about six weeks some of the sort of a

result that we had before and after

photographs and this is it shows the

loss of tone of the abdominal wall from

the pregnancy basically the size of the

baby has stretched the abdominal wall

muscles and we would ring back at it

it's a dramatic difference and you can

see the scar right there in the lower

abdomen and it brought brings back the

muscle back to the midline and it takes

away all the stretch marks or like such

disgusting excess skin sorry this is

another example of loss of tone and

we've actually basically brought back

tone to the Donna wall this is the front


sometimes there's excessive skin and fat

and the lower abdomen and all that is

pretty much removed entirely and the

belly button is the same as her belly

button except it's rejuvenated it looks

healthier it looks like it's more young

looking so to speak and it's an another

example of a side view of a getting

toned back at a down a wall c-section

scars a lot of women complained that

their c-section scars why do they look

so ugly after after having a c-section

well during during birth the only thing

they're worried about is actually the

baby and the health of the mom and the

c-section closure is the last thing on

their mind so it's closed in a hurry and

it's closed in one layer most of the

time so what we do is we recreate the

incision and we try to close it as best

as we can so we try to disperse the

tension of the wound across the entire

edge of the entire length of the wound

and we close it in three layers

as opposed to one to two layers and

recovery is very minimal it's an

outpatient procedures

I don't even restrict patients to any

any activity restrictions whatsoever

sometimes the the location of scar is

too high in the abdominal wall we can

louver it and depending on how high it

is and we can that can be done so that

it can be covered by any underwear that

they women wears and and sometimes we

can find it we combine it with what's

called a mini tummy tuck or

abdominoplasty or a full tummy tuck this

is an example of a c-section scar that's

not addressed I wanted to show you a

picture of what it looks like so it

looks like there's a shadow created by

the scar and there's a little bit of

fold above it so what we do is we fix

that we fixed we recreate the scar get

rid of this tiny fold and produce the

flat abdominal wall with the scar in the

middle of it that overtime fades and you

hardly ever notice it liposuction is a

very very common procedure after

pregnancy and it's something that may

not be caused by pregnancy but becomes

evident more after pregnancy and

liposuction is not designed I want to

repeat that is not designed to help a

woman lose weight designed to address

those little pockets of fat no matter

how much you exercise how are hard you

diet it doesn't go away and it's very

good for those areas and it takes only a

few days to recover and sensory change

is what I mean by that is the lipo

system causes some sort of weird change

in the skin sensation and usually like

feels like things women describe it at

things crawling on the dead skin that

usually goes away again it corrects

localized deformities correct

asymmetries between right and left and

however you cannot do liposuction on

someone who has very lot of excess skin

you actually make that excess skin worse

by taking the fat away so you sometimes

we combine liposuction we come it up for

example sometimes we do a mini tummy

tuck and liposuction so it's very it's

very logical to actually combine


meaning what the problem is usually we I

ask patients to wear a compression

garment it's usually girdle or a sort of

a compression garment around the arms

whatever the liposuction areas are for

about three weeks in the winter my

husband to wear about six weeks because

the more compression you wear the better

the result and then usually if they're

very very fair-skinned individuals

there's bruising about two to three

weeks again most of us honours and

outpatient procedures sometimes if

there's a high volume of liposuction we

require a patient to stay overnight for

safety reasons and 10% reoperation a lot

of times you know we do the liposuction

for example there are asymmetries

between right and left we try to make

them symmetric in the operating room but

it's too much swelling we get confused

sometimes and sometimes the leftover

sort of a deposit remains we address

those later at no cost to the patient

obviously the liposuction doesn't take

long it takes anywhere from one to three

hours depending on how much it's being

structured and how many body parts so to

speak usually they're back to work very

quickly and exercise right away

depending on how much pain they're in

and I usually use very tiny scars to

perform the liposuction I usually hide

the scars in a in a natural crease is

that one of the results from pre and

post liposuction these are outside thigh

liposuction before and after and it's a

dramatic sort of improvement this is

from the view from behind again the

lateral thighs and it is another example

of outside thigh liposuction before and

after next procedure we do offer is

breast augmentation so usually the

implant is placed whether it's silicone

or saline it's placed underneath the

muscle so that deflection of or

mammogram is not does not is not

interfered with and usually we place the

incisions and the fold of the breast or

at the edge of the areola fills the

upper Pole deficit this is the most

common side effect of

see and or breastfeeding where the

breast loses the upper portion it

becomes flat to flat at the top and this

is what breast augmentation addresses

most most efficiently okay it's an

operation procedures done under general

anesthesia it's about a two hour surgery

and seven to ten day recovery and

usually you can have taken women can go

back to full physical activity at about

three to four weeks the two common types

of implants now are saline and silicone

are there any other types yes there are

other types are they but non-fda

approved only silicone and saline are

there are some other material for

example soy products are being

introduced in the market slowly but not

quite at the approved yet there is no

difference between the two in the way in

the way how long they live they rupture

at the same rate they the lifespan of an

implant whether it's silicone or saline

is it same and the only thing the

difference about them is that the fact

that they behave differently when they

rupture a saline implant when it's

ruptured it goes flat because it's full

of saline saline is a natural fluid that

runs in our blood so body just reabsorbs

it as opposed to silicone when in

silicone ruptures the breast will be

start becoming firm not over days or

weeks but over months and years and one

day a woman may may realize that one

breast is firmer than the other one then

there is an assumption that the implant

is ruptured and an MRI is performed

confirmed rupture and we usually like to

change it at that point

however silicone in my opinion is

superior with respect to how it feels

and respect to how it looks it looks

more natural it looks more breast like

as opposed to a saline implant which

feels more like a water balloon these

are some examples of before and after

silicone implantation and there's a

six-month period between the two and

what I'm talking about is this this

right here where pregnancy and or

breastfeeding will shallow the top of

the breast and this is what an implant

addresses most most efficiently there's

an another example of I'll show this

picture because it's immediately after


and again it addresses the top pole

really really nicely again before and

after and one last one this is at the

end of surgery in the recovery room and

the my marking was still fresh I just

want to do several pictures six months

out many years out and immediately after

operation this is about two years out

and then the result maintained

themselves it's a very very sort of long

lasting procedure and again this is post

pregnancy that did not breastfeed

however there were some changes with

pregnancy but again we addressed it

it's another patient again the most

common effect of pregnancy is losing the

top pole of the breast with a breast

reduction this is probably one of the

only procedure that may be covered by

insurance it depends on the height of

the patient it depends on the weight of

the patient it depends how much I

estimate that I will remove usually

insurance companies require about

three-quarters of a pound per breast

breast tissue removal to be able to

cover by insurance and they usually

correlate that with the height and

weight of the patient so we reshape the

breast we give it a perk so to speak and

the process of breast reduction we

actually make the breast perkier and it

gets rid of back pain neck pain

posture is improved overall it's a very

very successful operation in resolving

neck and posture issues and improves

exercise dollars most women lose a lot

of weight after breast reduction because

they get motivated it takes me about

three hours to perform the procedures I

stopped using drainage tubes and breast

reduction patients I don't we don't need

them I usually ask them to wear a sports

bra for three weeks they're back at work

at two weeks and they usually start

exercising in about six weeks

the one thing I have to mention about

breast reduction is the fact that it

adds significant scars to the breast and

they're the they're the shape of a

ship's anchor they go around the areola

down to the fold and end the fold and

the 15 year practice I've been at UCLA

I'm yet to receive a

about how the scars look because the

overall benefit the aesthetic benefit

and the back pain benefit fun direction

is so good that people don't even talk

about their scars there's an example of

before-and-after this is only about one

month after surgery and a significant

significant improvement in posture the

groove of the shoulders disappear the

back pain disappears the posture

disappears and the exercise colors and

increases is an another example of an

extreme case of breast reduction before

and after mastopexy is basically the

same operation as reduction where it

produces perkiness of the breast weed

out the loss of volume essentially it's

a breast lift and scars are exactly the

same as a breast reduction at the ship's

anchor looking scar and it basically it

looks like like that on a sort of a

animated view it reshapes the breast

lifts it and in return an anchor pattern

scar is placed and recoveries again is

about two to three weeks out of the

breast reduction here's an example of

extreme sort of post pregnancy weight

loss that led to sort of drop of the

breasts and we lifted it for her she's

very happy with it it's not that she

didn't want to be augmented she just

want to be lifted another example of

lift without loss of volume I just

wanted to give you a sort of a broad

introduction of the kind of procedure

that we can offer and I want to thank

you for listening in I do understand

that there are some several questions

that that were asked and I can I can

happy to answer right now but if we're

the one first question is what if I'm

done having kids can I still have this

procedure actually we like you to have

this procedure after you're done having

kids because having this procedure

before having kids is you know and

another pregnancy will actually ruin

this also the ideal thing to do is be

done with having kids and then address

the problem at that point so that's

probably the most ideal time to perform

and another question is if silicone

implants safe it's extremely safe it's

been proven now over 50,000 women have

had silicone implants since 2007 that's

when the FDA approved silicone implant

to a point where I prefer silicone or

saline because it's because of its

safety the areas of liposuction grow

back grow fat back and they don't they

don't grow from the area of the

liposuction the amount of fat cells that

were removed from a certain party part

to not come back if a woman gains weight

the body dispersed it in all other areas

except that area ah regular procedures

covered by insurance as I address it in

the talk usually breast reduction is

probably the only one that will be

covered by insurance and has to do with

height and weight and the size of the

reduction is that's what it's relevant

but probably the only procedure out of

the ones I listed that has a likelihood

of getting covered by insurance again

thank you so much for listening in and

hope to do this again in the future and

hope to hover some helpful tips if I can

and thank you again