Mainstreaming the Mommy Makeover w/ Dr. Munique Maia

Doreen Wu (00:00):
Welcome to Park Avenue Plastic Surgery Class, a podcast where we explore controversies and breaking issues in plastic surgery. I'm your co-host, Doreen Wu, a clinical assistant at Bass Plastic Surgery in New York City. I'm excited to be here with Dr. Lawrence Bass, Park Avenue plastic surgeon, educator and technology innovator. The title of today's episode is Mainstreaming the Mommy Makeover. Dr. Bass, give me the lowdown. What is a mommy makeover and what is the idea behind it?

Dr. Lawrence Bass (00:32):
The mommy makeover is designed to provide a general body reset after having a baby. It focuses on improving two areas, the tummy or abdominal area and the breast area. These are two of the areas typically most impacted by the effects of pregnancy. We've always done procedures to improve body contour, the torso specifically. This includes tummy tuck or abdominoplasty, and later the advent of liposuction. For the breast area, breast augmentation or breast lift, medically known as mastopexy, may be needed. Putting these two sets of procedures together in one procedure with one recovery is what we usually refer to as a mommy makeover. So with that, let me introduce our guest. Joining us again is Dr. Munique Maia. She is one of our former residents in the Northwell program who completed the aesthetic fellowship at Harvard and is now a very busy and popular plastic surgeon in the Washington DC metro area.

(01:52):
Dr. Maia, welcome.

Dr. Munique Maia (01:54):
Thank you. Thank you for having me.

Dr. Lawrence Bass (01:57):
Can you add anything to my description of the mommy makeover? Are there any new twists?

Dr. Munique Maia (02:03):
Yeah, so as you mentioned, it's usually breast and body surgical procedures combined, but not all the patients want to undergo these big procedures. Sometimes what I see patients come, they want to sometimes just reshape the body, just have a little bit of liposuction. Not everybody has extra skin should be removed. Sometimes they just improve, they want to improve the C-section scar. They're just bothered by the shelf and then sometimes depression related to C-section scars. So not all patients would like or benefit from a big mommy makeover. And also other common non-invasive procedures that can be done after childbirth, like for example, lasers for stretch marks, which they have some results, but depending up of how the stretch marks are, you can do other treatments like radiofrequency. Sculpture also helps to improve skin quality. We have new technologies with skin tightening devices that can help a little bit if the patient has mild skin laxity.

(03:22):
So these are important things to mention. Not everybody is a candidate for the mommy makeover. So you can also discuss with your plastic surgeon which other procedures can be done that not necessarily involves big surgery. Even a mini tummy tuck, sometimes it's possible for very selected patients.

Dr. Lawrence Bass (03:47):
Yeah, I think that's really a great point. Sometimes I'll just take a tethered C-section scar and through a puncture incision using a forked liposuction cannula. Some of those scars can be very simply released with little, if any, recovery time and really correct that little acquired deformity. And there are a lot of variations in abdominoplasty. And I think it's sort of important to be flexible, listen to patients and see really what their concern is. Occasionally a mini skin only removal is worthwhile for some patients. It really depends exactly what's going on in their anatomy and what's bothering them.

Dr. Munique Maia (04:37):
That's right. A lot of patients also come, thin patients don't have a lot of skin laxity. Sometimes they just need a muscle straightening, which they can try physical therapy for the diastasis repair. And there are new technologies that also can help a little bit with the diastasis. So that's something to keep in mind.

Doreen Wu (05:02):
And Dr. Maia, you talked about who is a good candidate for this procedure. So who should be considering a mommy makeover? Is it for new mothers? Is it for women after they have had all their children? Or is it more appropriate later in aging?

Dr. Munique Maia (05:17):
That's a great question. So ideally this procedure should be performed after you are done having children. Your body will change after each pregnancy. But having said that, I have performed tummy tucks for patients that did not have kids but had massive weight loss. After massive weight loss, you have a lot of excessive skin, and that's bothersome for a lot of patients. So usually I have long conversation with my patients and explain the pro and cons of each procedure and see if that time is ideal for them. So it's not the age, it's the need for that particular procedure.

Dr. Lawrence Bass (05:59):
Yeah, I think that's an important point. And also important to know is sometimes you unexpectedly have another child that you weren't necessarily planning on. That's safe after having breast and tummy surgery, but it will undo the abdominoplasty in large part. And as Dr. Maia said, there'll be new shape changes from the new pregnancy. Some ladies don't have time. They're busy with new children and they don't get to the makeover until they're somewhat older and that's okay. It's still beneficial. And it always bugged them, but they just couldn't with multiple small children running around the house take the time out to do it. Maybe a small treatment, as Dr. Maia mentioned, could be helpful as a stopgap, and then they get to the mommy makeover when they're a little freer and easier with older children.

Doreen Wu (07:05):
Now let's talk about the breasts. How do you decide whether a patient needs a mastopexy or a breast lift versus a breast augmentation?

Dr. Munique Maia (07:15):
So my approach to breast rejuvenation surgery is that shape and size are both important. And I usually discuss with the patient shape is even more important than size. So if the breasts are sagging and you perform a breast augmentation with an implant, the final shape will not be ideal. It's important to understand this concept. As plastic surgeons, we like to minimize the scars as much as possible, but if skin needs to be removed, the scars are needed. So I explain to the patient that these scars will heal pretty well, and then it's better to have a better shape and size breasts, which is a beautiful rejuvenation of the breast. But that scars, we need to add some scars to reshape the breasts. And that scars usually heal pretty well and not very visible.

Dr. Lawrence Bass (08:12):
Yeah. The shape of the breast is important. The position of the breast on the body is important. And a sagging breast is no longer ideally centered on the chest. And putting an implant under where the breast is really not quite the right place if there's a lot of sagging in the breast. So repositioning the breast where it came from with or without augmentation is sometimes we do an augmentation mastopexy, creates the ideal in shape, the patient's desire in size, and the ideal in position of the breast on the body.

Doreen Wu (08:57):
Now, in addition to the breast rejuvenation component, the mommy makeover also addresses the tummy. What are some variations in the abdominal component?

Dr. Munique Maia (09:07):
So when a patient comes for consultation, the plastic surgery, we analyze the abdomen and we are looking at different structures. Usually we look at the skin, the excessive skin, fat, and also the muscle. So in conversation with the patient, we can determine which structures they think we need to work on. A lot of patients just want to remove some fat or they want to do everything in combination. So very few patients after a pregnancy can do liposuction alone because there's usually a skin component that you need to remove. Having said that, if it's mild laxity, you can still do non-invasive treatments with radiofrequency. That can help. As I mentioned before, very few patients are a candidate for non-invasive treatments or even a mini tummy tuck. A mini tummy tuck will just address a small amount of excessive skin. So most patients will need a full tummy tuck and that will address all the structures that we mentioned, which is the skin, the fat, and the muscle separation.

(10:18):
So with a full tummy tuck, we do muscle repair, which is the diastasis repair. We do liposuction and also skin removal.

Dr. Lawrence Bass (10:28):
Yeah, that's important. And as I said earlier, looking at variations based on what's present in the individual patient is very important. And sometimes there are other considerations as well. I had a patient recently who is Indian and she wears on occasion traditional clothing, which shows her middle. And she did not want an incision around the belly button because that would show in that clothing. And fortunately for her, the skin and excess tissue was mostly located very low down on her abdomen. And so we fashioned the procedure that largely was skin removal and muscle glycation using an extended mini approach. So the incision was longer than a mini, but the removal was only at the bottom of the abdomen, which matched her needs and kept the scar off the belly button as would've been in a full abdominoplasty. So these are individual circumstances and that kind of customization after the careful and appropriate analysis that Dr. Maia mentioned of each of the components and how much change is present, that's really the key to getting the right answer.

Dr. Munique Maia (11:53):
So with modern techniques, abdominoplasty, you can do this procedure in about two and a half, three hours. And usually we add liposuction as well to improve the shape of the midsection. And recovery time is about two to three weeks.

Dr. Lawrence Bass (12:12):
And tell me, so you liposuction most of your patients. And are you willing to be aggressive in liposuctioning the upper as well as the lower tissues are coming out, skin and fat, but the upper tissues, do you just liposuction some or are you willing to be fairly aggressive, assuming the patient's not obese or smoker or something like that?

Dr. Munique Maia (12:39):
So I'm usually more conservative on the abdominal flap. So the upper part of the abdomen, I'm more aggressive when I do liposuction of the flanks.

Dr. Lawrence Bass (12:49):
Yeah. And so that's often included as well. The waist area or flanks, what some people call low love handles often have accumulated some shape change with pregnancy and liposuction at the same time as the tummy tuck is very commonly performed. And again, I agree that aggressively suctioning those areas is safe in patients who don't have another risk factor.

Dr. Munique Maia (13:19):
Yeah. And that's one important question that Dr. Bass mentioned is that you cannot do aggressive liposuction in the area above the belly button. The reason is you can compromise blood supply and compromise healing, even have skin problems later on. So it's not something that can be done without risks.

Doreen Wu (13:43):
From our discussion so far, I'm wondering, how is the mommy makeover different from when the component procedures are done individually?

Dr. Munique Maia (13:52):
So some of these procedures can be done in combination or separately. One of the main advantages is that you have one recovery time. There are patients, as Dr. Bass asked, do you do liposuction, like aggressive liposuction on the whole abdomen? So there are patients that do need aggressive liposuction to get better shape. And these patients will need that to stage the procedure because it's not safe to do aggressive liposuction and tummy tuck at the same time. And sometimes you have to separate these procedures also if you think the procedure will take more than six hours. For example, if you do a mommy makeover with a mastopexy in a tummy tuck, you want to perform both procedures in less than six hours. If there is a situation like a complex mastopexy with tuberous breast or more liposuction areas, it's better if you do this in two stages.

(14:59):
Because as the procedure becomes longer, the risks will be increased, especially if you think about DVT, which are blood clots. So I do stage my procedures if I think that it will take more than six hours.

Doreen Wu (15:18):
Dr. Bass, in your practice, are there any other circumstances where someone should not do the procedures combined and instead should separate them?

Dr. Lawrence Bass (15:26):
I think Dr. Maia really summarized it well. When an individual component is going to be unusually complex, you're probably better focusing all your energy and concentration on that single feature and not be constrained by time. The time constraint is a safety consideration and just a practical consideration for aesthetic surgery. So I think that those are the principle issues in a nutshell.

Doreen Wu (16:00):
Lastly, before we conclude, Dr. Bass, what should our listeners take away from today's episode?

Dr. Lawrence Bass (16:06):
The mommy makeover can really do an extraordinarily good job of resetting body appearance after pregnancy. However, unfortunately we can never be 20 again. We can never be exactly the same body that we had before pregnancy. There's always some differences, but the vast majority of the changes can be chased effectively with a procedure like a mommy makeover. That being said, there's a lot of variation and customization of the plan is critical. And that's where an experienced plastic surgeon comes in who has good judgment and spends time talking with patients and hearing their concerns. Because if you've had one pregnancy, your body may have one set of changes. If you've had three, four, five children, the body can sort of take a joke once. Sometimes a lot of things come back fairly close to where they were after one pregnancy, but after multiple pregnancies, muscle diastasis or separation is going to be a significant consideration for sure.

(17:24):
The degree of volume change, atrophy, drooping in the breast is going to be much more pronounced. So this has to be adjusted for each individual, and that's the key to hitting a home run with the mommy makeover.

Doreen Wu (17:40):
Dr. Maia, any takeaways you would like to add?

Dr. Munique Maia (17:43):
Yeah, so mommy makeover procedures are very popular and have a high satisfaction rate. I think it's super important for patients to find a board certified plastic surgeon who perform these procedures regularly. So it's important to look at the website, look at before and after pictures. One important thing to look at is look at the belly button, see if you like this course. We take the extra time to hide these scars, make a beautiful belly button so you don't have the telltale signs of a tummy tuck. The other thing, there's no age for tummy tuck. I do perform in tummy tucks as patients as old as in their 60s, mid - 60s. You can see beautiful pictures on the website of patients that age group. So there's never too late to get a tummy tuck. I think it's important for patients to find the local plastic surgeon, talk to them, get their questions answered.

(18:44):
As I said, it's a very popular procedure. Sometimes it can be life-changing. I have patients that they tell me then they haven't wore a bikini in like 20 years and now in their 50s and 60s they're back and then they live their best life. And that's what it's all about. Plastic surgery is about quality of life, and we are here to help patients to feel their best and perform safe surgery.

Doreen Wu (19:10):
Great points all around. Thank you, Dr. Maia, Dr. Bass, for sharing your insight and expertise on this increasingly popular procedure in plastic surgery.

Dr. Munique Maia (19:18):
Thank you, Doreen.

Dr. Lawrence Bass (19:19):
And thank you to Dr. Maia for coming back on the podcast and sharing her expertise. It was a pleasure having you.

Dr. Munique Maia (19:28):
Thank you.

Doreen Wu (19:30):
Thank you for listening to the Park Avenue Plastic Surgery Class Podcast. Follow us on Apple Podcasts, write a review, and share the show with your friends. Be sure to join us next time to avoid missing all the great content that's coming your way. If you want to contact us with comments or questions, we'd love to hear from you. Send us an email at podcast@drbass.net or DM us on Instagram @drbassnyc.