Mainstreaming the Mommy Makeover w/ Dr. Munique Maia

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Welcome to Park Avenue
Plastic Surgery Class,

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a podcast where we explore controversies
and breaking issues in plastic surgery.

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I'm your co-host, Doreen Wu,

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a clinical assistant at Bass
Plastic Surgery in New York City.

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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,

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educator and technology innovator.

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The title of today's episode is
Mainstreaming the Mommy Makeover.

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Dr. Bass, give me the lowdown.

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What is a mommy makeover and
what is the idea behind it?

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The mommy makeover is designed
to provide a general body

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reset after having a baby.

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It focuses on improving two areas,

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the tummy or abdominal
area and the breast area.

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These are two of the areas typically
most impacted by the effects of

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pregnancy.

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We've always done procedures
to improve body contour,

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the torso specifically.

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This includes tummy
tuck or abdominoplasty,

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and later the advent of liposuction.

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For the breast area, breast
augmentation or breast lift,

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medically known as
mastopaxy, may be needed.

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Putting these two sets of procedures
together in one procedure with

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one recovery is what we usually
refer to as a mommy makeover.

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So with that, let me introduce our guest.

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Joining us again is Dr. Munique Maia.

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She is one of our former residents in
the Northwell program who completed the

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aesthetic fellowship at Harvard
and is now a very busy and popular

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plastic surgeon in the Washington
DC metro area. Dr. Maia,

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welcome.

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Thank you. Thank you for having me.

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Can you add anything to my
description of the mommy makeover?

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Are there any new twists?

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Yeah, so as you mentioned,

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it's usually breast and
body surgical procedures

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combined,

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but not all the patients want
to undergo these big procedures.

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Sometimes what I see patients come,

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they want to sometimes
just reshape the body,

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just have a little bit of liposuction.

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Not everybody has extra
skin should be removed.

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Sometimes they just improve, they
want to improve the C-section scar.

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They're just bothered by the shelf
and then sometimes depression

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related to C-section scars.

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So not all patients would
like or benefit from

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a big mommy makeover. And also

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other common non-invasive procedures
that can be done after childbirth,

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like for example, lasers for
stretch marks, which they have

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some results, but depending up
of how the stretch marks are,

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you can do other treatments
like radiofrequency.

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Sculpture also helps to
improve skin quality.

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We have new technologies with
skin tightening devices that can

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help a little bit if the patient
has mild skin laxity. So these are

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important things to mention.

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Not everybody is a candidate
for the mommy makeover.

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So you can also discuss with your plastic
surgeon which other procedures can be

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done that not necessarily
involves big surgery.

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Even a mini tummy tuck, sometimes
it's possible for very selected

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patients.

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Yeah, I think that's really a great point.

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Sometimes I'll just take a tethered
C-section scar and through a puncture

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incision using a forked
liposuction cannula.

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Some of those scars can be very
simply released with little,

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if any,

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recovery time and really
correct that little acquired

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deformity. And there are a lot of

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variations in abdominoplasty. And I think
it's sort of important to be flexible,

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listen to patients and see
really what their concern is.

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Occasionally a mini skin only removal

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is worthwhile for some patients.

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It really depends exactly what's
going on in their anatomy and

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what's bothering them.

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That's right. A lot of patients also come,

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thin patients don't have
a lot of skin laxity.

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Sometimes they just need
a muscle straightening,

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which they can try physical
therapy for the diastasis repair.

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And there are new technologies that
also can help a little bit with the

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diastasis. So that's
something to keep in mind.

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And Dr. Maia, you talked about who is
a good candidate for this procedure.

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So who should be considering a mommy
makeover? Is it for new mothers?

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Is it for women after they
have had all their children?

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Or is it more appropriate later in aging?

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That's a great question.

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So ideally this procedure should be
performed after you are done having

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children. Your body will
change after each pregnancy.

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But having said that,

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I have performed tummy tucks for patients
that did not have kids but had massive

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weight loss. After massive weight
loss, you have a lot of excessive skin,

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and that's bothersome
for a lot of patients.

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So usually I have long conversation
with my patients and explain the

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pro and cons of each procedure
and see if that time is ideal for

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them. So it's not the age,

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it's the need for that
particular procedure.

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Yeah, I think that's
an important point. And

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also important to know is sometimes
you unexpectedly have another

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child that you weren't
necessarily planning on.

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That's safe after having
breast and tummy surgery,

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but it will undo the
abdominoplasty in large part.

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And as Dr. Maia said,

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there'll be new shape changes
from the new pregnancy.

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Some ladies don't have time.

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They're busy with new
children and they don't get to

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the makeover until they're
somewhat older and that's okay.

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It's still beneficial.
And it always bugged them,

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but they just couldn't with multiple
small children running around the house

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take the time out to do it. Maybe a
small treatment, as Dr. Maia mentioned,

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could be helpful as a stopgap,

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and then they get to the mommy makeover
when they're a little freer and

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easier with older children.

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Now let's talk about the breasts.

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How do you decide whether a patient
needs a mastopexy or a breast lift

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versus a breast augmentation?

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So my approach to breast rejuvenation
surgery is that shape and size are

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both important.

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And I usually discuss with the patient
shape is even more important than size.

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So if the breasts are sagging and you
perform a breast augmentation with an

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implant, the final
shape will not be ideal.

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It's important to understand this
concept. As plastic surgeons,

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we like to minimize the
scars as much as possible,

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but if skin needs to be
removed, the scars are needed.

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So I explain to the patient that
these scars will heal pretty well,

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and then it's better to have a
better shape and size breasts,

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which is a beautiful
rejuvenation of the breast.

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But that scars,

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we need to add some scars
to reshape the breasts.

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And that scars usually
heal pretty well and

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not very visible.

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Yeah. The shape of the
breast is important.

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The position of the breast
on the body is important.

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And a sagging breast is no longer
ideally centered on the chest.

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And putting an implant under where the
breast is really not quite the right

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place if there's a lot
of sagging in the breast.

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So repositioning the
breast where it came from

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with or without augmentation
is sometimes we do an

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augmentation mastopexy,

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creates the ideal in shape,

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the patient's desire in size,

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and the ideal in position
of the breast on the body.

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Now, in addition to the
breast rejuvenation component,

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the mommy makeover also
addresses the tummy.

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What are some variations
in the abdominal component?

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So when a patient comes for
consultation, the plastic surgery,

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we analyze the abdomen and we are
looking at different structures.

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Usually we look at the skin, the
excessive skin, fat, and also the muscle.

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So in conversation with the patient,

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we can determine which structures
they think we need to work on.

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A lot of patients just want to remove
some fat or they want to do everything in

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combination.

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So very few patients
after a pregnancy can do

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liposuction alone because there's
usually a skin component that you need to

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remove. Having said that,
if it's mild laxity,

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you can still do non-invasive treatments
with radiofrequency. That can help.

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As I mentioned before,

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very few patients are a candidate for
non-invasive treatments or even a mini

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tummy tuck.

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A mini tummy tuck will just address
a small amount of excessive skin.

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So most patients will need a full tummy
tuck and that will address all the

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structures that we mentioned,
which is the skin, the fat,

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and the muscle separation.
So with a full tummy tuck,

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we do muscle repair, which
is the diastasis repair.

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We do liposuction and also skin removal.

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Yeah, that's important.
And as I said earlier,

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looking at variations based
on what's present in the

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individual patient is very important.

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And sometimes there are
other considerations as well.

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I had a patient recently
who is Indian and she wears

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on occasion traditional
clothing, which shows her middle.

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And she did not want an incision
around the belly button because

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that would show in that clothing.
And fortunately for her,

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the skin and excess tissue was
mostly located very low down on

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her abdomen.

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And so we fashioned the
procedure that largely was skin

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removal and muscle glycation
using an extended mini

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approach. So the incision
was longer than a mini,

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but the removal was only at
the bottom of the abdomen,

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which matched her needs and kept
the scar off the belly button as

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would've been in a full abdominoplasty.

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So these are individual circumstances
and that kind of customization

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after the careful and appropriate
analysis that Dr. Maia mentioned

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of each of the components and
how much change is present,

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that's really the key to
getting the right answer.

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So with modern techniques, abdominoplasty,

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you can do this procedure in
about two and a half, three hours.

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And usually we add liposuction as
well to improve the shape of the

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midsection. And recovery time
is about two to three weeks.

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And tell me, so you liposuction
most of your patients.

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And are you willing to be aggressive
in liposuctioning the upper

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as well as the lower tissues
are coming out, skin and fat,

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but the upper tissues,

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do you just liposuction some or are
you willing to be fairly aggressive,

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assuming the patient's not obese
or smoker or something like that?

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So I'm usually more conservative
on the abdominal flap.

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So the upper part of the abdomen,

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I'm more aggressive when I
do liposuction of the flanks.

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Yeah. And so that's often included
as well. The waist area or flanks,

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what some people call low love
handles often have accumulated some

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shape change with pregnancy and
liposuction at the same time as the

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tummy tuck is very commonly
performed. And again,

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I agree that aggressively
suctioning those areas is safe

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in patients who don't
have another risk factor.

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Yeah.

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And that's one important question that
Dr. Bass mentioned is that you cannot

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do aggressive liposuction in
the area above the belly button.

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The reason is you can compromise
blood supply and compromise

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healing, even have skin problems later on.

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So it's not something that
can be done without risks.

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From our discussion so far, I'm wondering,

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how is the mommy makeover different from
when the component procedures are done

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individually?

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So some of these procedures
can be done in combination

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or separately. One of the main advantages
is that you have one recovery time.

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There are patients, as Dr. Bass asked,

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do you do liposuction,

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like aggressive liposuction
on the whole abdomen?

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So there are patients that do
need aggressive liposuction
to get better shape.

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And these patients will need that
to stage the procedure because

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it's not safe to do aggressive liposuction
and tummy tuck at the same time.

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And sometimes you have to
separate these procedures also

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if you think the procedure will take
more than six hours. For example,

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if you do a mommy makeover with
a mastopexy in a tummy tuck,

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you want to perform both
procedures in less than six hours.

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If there is a situation like a
complex mastopexy with tuberous breast

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or more liposuction areas,

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it's better if you do this in two stages.
Because

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as the procedure becomes longer,
the risks will be increased,

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especially if you think about
DVT, which are blood clots.

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So I do stage my
procedures if I think that

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it will take more than six hours.

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Dr. Bass, in your practice,

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are there any other circumstances where
someone should not do the procedures

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combined and instead should separate them?

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I think Dr. Maia really
summarized it well.

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When an individual component
is going to be unusually

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complex,

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you're probably better focusing all
your energy and concentration on

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that single feature and
not be constrained by time.

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The time constraint is a
safety consideration and just

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a practical consideration
for aesthetic surgery.

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So I think that those are the
principle issues in a nutshell.

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Lastly, before we conclude, Dr. Bass,

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what should our listeners take
away from today's episode?

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The mommy makeover can really
do an extraordinarily good job

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of resetting body
appearance after pregnancy.

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However, unfortunately
we can never be 20 again.

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We can never be exactly the same body

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that we had before pregnancy.
There's always some differences,

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but

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the vast majority of the changes
can be chased effectively with a

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procedure like a mommy
makeover. That being said,

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there's a lot of variation
and customization of the plan

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is critical.

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And that's where an experienced
plastic surgeon comes in who has

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good judgment and spends time talking
with patients and hearing their concerns.

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Because if you've had one pregnancy,

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your body may have one set of changes.
If you've had three, four, five children,

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the body can sort of take a joke once.

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Sometimes a lot of things come back
fairly close to where they were

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after one pregnancy, but
after multiple pregnancies,

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muscle diastasis or separation
is going to be a significant

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consideration for sure.
The degree of volume change, atrophy,

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drooping in the breast is going
to be much more pronounced.

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So this has to be adjusted
for each individual,

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and that's the key to hitting a
home run with the mommy makeover.

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Dr. Maia, any takeaways
you would like to add?

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Yeah,

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so mommy makeover procedures are very
popular and have a high satisfaction rate.

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I think it's super important for patients
to find a board certified plastic

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surgeon who perform these
procedures regularly.

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So it's important to look at the website,
look at before and after pictures.

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One important thing to look at
is look at the belly button,

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see if you like this course.

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We take the extra time
to hide these scars,

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make a beautiful belly button so you
don't have the telltale signs of a tummy

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tuck. The other thing,
there's no age for tummy tuck.

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I do perform in tummy
tucks as patients as old

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as in their 60s, mid - 60s.

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You can see beautiful pictures on the
website of patients that age group.

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So there's never too
late to get a tummy tuck.

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I think it's important for patients
to find the local plastic surgeon,

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talk to them,

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get their questions answered.
As I said, it's a very popular procedure.

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Sometimes it can be life-changing.

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I have patients that they tell me then
they haven't wore a bikini in like 20

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years and now in their 50s and 60s
they're back and then they live their

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best life. And that's what it's all about.

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Plastic surgery is about quality of life,

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and we are here to help patients
to feel their best and perform safe

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surgery.

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Great points all around.
Thank you, Dr. Maia, Dr. Bass,

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for sharing your insight and expertise
on this increasingly popular procedure in

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plastic surgery.

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Thank you, Doreen.

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And thank you to Dr. Maia for coming
back on the podcast and sharing

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her expertise. It was
a pleasure having you.

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Thank you.

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Thank you for listening to the Park
Avenue Plastic Surgery Class Podcast.

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Follow us on Apple
Podcasts, write a review,

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00:19:36,520 --> 00:19:37,760
and share the show with your friends.

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00:19:38,120 --> 00:19:41,440
Be sure to join us next time to avoid
missing all the great content that's

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coming your way. If you want to
contact us with comments or questions,

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we'd love to hear from you.

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Send us an email at podcast@drbass.net
or DM us on Instagram

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