Mommy Makeover
Mommy Makeover Consultation and Physical Exam
We have outlined below what you can expect from your abdominoplasty and breast consultation. Read carefully, as there are many suggestions that will save you time, answer questions, and help you to convey to your plastic surgeon what you want to accomplish.
Health History
All cosmetic surgery consultations begin with a thorough health history. This is especially true if general anesthesia is being used, but also applies to local anesthesia. Tummy tucks and breast surgeries are almost always done under general anesthesia because of the extensive amount of tissue undermining necessary. For this reason it is especially important that your health is optimized. Prior to meeting with Dr. Cruise you will be given a health history questionnaire to fill out in the waiting area. There are five areas of your health you will be asked about. Be sure to answer questions in detail so that surgery and anesthesiology can be optimized for you.
General Health
General health problems are important to discuss so that your surgery is as safe as possible. Be sure to mention any chronic illness. Of particular concern are high blood pressure, diabetes, heart problems, liver and kidney disease, stroke, cancer, bleeding problems, and wound healing problems.
If you have medical problems, Dr. Cruise will make sure your health is optimized as much as possible to ensure your safety. This may mean referring you to your private physician.
If you have a health problem, you can often save time by bringing a letter from your private physician to your cosmetic consultation, stating what the health problem is, how it is being treated, and whether or not you are able to tolerate general anesthesia safely.
If you are seeing any specialist (cardiologist, kidney doctor, psychiatrist, etc. ) be sure to bring a letter from them stating you are able to tolerate surgery.
Be sure to let Dr. Cruise know if you have ever had a blood clot. Abdominoplasties have a high incidence of causing blood clots compared to any other cosmetic procedure.
Past Surgical History
The questionnaire asks about previous surgeries. Be sure to identify any problems you may have had with anesthesia. Of particular concern are previous cosmetic surgeries, especially if you do not like the result and are interested in revision. With abdominoplasty, it is especially important to mention all abdominal surgeries including C-section, gall bladder, and hernia operations. With breast augmentation it is especially important to mention all breast surgeries including breast biopsies.
Medications
Be sure to list all medications you take including aspirin and over-the-counter medications. These are important as they may increase bleeding and affect your surgery. It is extremely important to stop taking aspirin and aspirin- containing products at least 2 weeks before surgery. Tylenol is a good alternative. Here is a partial list of aspirin containing products and other products to be avoided prior to surgery.
Allergies to Medications
Information about medications that cause allergic reactions is very important so that these medications can be avoided. Of particular importance is the type of reaction you had, especially if you had trouble breathing. Be sure to include this information! Nausea is not an allergic reaction, but it is important to mention as well.
Smoking, Drinking and Drug Use
These will certainly affect your surgery and must be mentioned so that your surgery can be optimized. Smoking causes a profound decrease in wound healing and will lead to worse scarring and a less favorable result. With large procedures such as a face lift, neck lift, tummy tuck, and breast lift, smoking must be stopped at least 6 weeks before and after surgery. Otherwise, the results could be disastrous leading to non-healing wounds, poor scarring, and/or infection. With smaller procedures such as eyelid surgery, nose surgery, breast augmentation, and liposuction, smoking will hurt the overall result but this may or may not be noticeable. In this case smoking cessation is strongly advised but is not mandatory.
Specific Abdominal Issues
During your consultation you must be very accurate about any abdominal problems. Of particular concern is a history of abdominal hernia. This problem must be addressed during your consultation. If a hernia is present, it can often be fixed during the surgery or if it is large it may need to be fixed with the help of a general surgeon. Another issue that complicates abdominoplasty is previous abdominal surgery. The scars may affect the blood supply of the skin. Once again, any history of blood clot must be discussed.
Physical Exam
The goal of the abdominal physical exam is to determine exactly what is causing the problem. Some problems can be treated with liposuction while others require a tummy tuck. Sometimes a combination of the two is best. This section will help you to decide what is best for you. Abdominal cosmetic surgery can be broken down into the following 5 categories: liposuction alone, mini-abdominoplasty, standard abdominoplasty, extended abdominoplasty and circumferential abdominoplasty.
- Liposuction
Liposuction alone is excellent when skin excess is not a problem and there is a localized excess fat deposit. Liposuction requires that the patient's skin has the ability to shrink once the fat is removed. Patients with poor skin quality, demonstrated by many stretch marks and cellulite, are not good candidates for liposuction. This is better discussed under the liposuction section. Often, patients convince themselves that "sucking this fat out" would give them a flat stomach. This may be true, but if they have a lot of excess skin, or their skin quality is poor, then they will be disappointed. Liposuction may leave them with loose, hanging skin often with waviness.
If there is a significant amount of excess skin, the only way to get rid of it is to cut it out via a tummy tuck. Frequently, non-plastic surgeons will perform liposuction and these patients end up with disappointing results. The scars caused by a tummy tuck are very long but this is almost never a complaint. Satisfaction is uniformly high. Once it has been decided that skin excision is necessary, the next question is how far to the back should the excision go. The answer is relatively straightforward.
- Mini-Abdominoplasty/Mini-Tummy Tuck
If your problem is limited to a small amount of loose skin and excess fat below the belly button, then a mini-abdominoplasty may be all that is necessary. As the name implies, a mini-abdominoplasty creates a smaller scar. The tradeoff, however, is that it may not obtain the results you are looking for. Generally, if you can only pinch an inch or two of skin, then this will probably suffice. The incision stays inside the hip bones, and the belly button is not transplanted like in a standard abdominoplasty. It is merely pulled downward toward the pubis. Abdominal muscle tightening is performed up to the level of the umbilicus. This markedly improves the abdominal "pooch."
- Standard Abdominoplasty/Standard Tummy Tuck
- Skin Excision
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Abdominal Muscle Tightening
- Belly Button Transposition
- Liposuction
- Extended Abdominoplasty/Extended Tummy Tuck
When the redundant skin goes around toward the back, then there is no other way to remove it but to extend the excision to include this area. This can be identified by grasping the skin over the lateral waist and around to the flanks. Extending the excision to include this skin and fat does a spectacular job of creating an “hourglass" figure. In doing so, the waist becomes much smaller. This makes the buttocks appear much more attractive and curvy. Furthermore, the breasts appear larger. The waist is now the focal point of the body around which everything else is evaluated. A smaller waist significantly impacts both the breasts and buttocks. The downsides of the extended abdominoplasty are the additional operating time necessary, the additional cost, and of course the longer scar.
Specific Breast Issues
During your consultation you must be very accurate about breast problems. Of particular concern is a history of breast masses and/or breast cancer. If you are over the age of 40, Dr. Cruise will require that you have a mammogram, documented by bringing a copy of the results to your consultation. If you haven't had a mammogram yet, you will be sent to a lab pre-operatively. If you, or a family member, have a history of breast cancer then this requirement may apply at age 35 or even 30. Breast augmentation has no effect on breast cancer. The only potential problem is mammogram screening. Mammograms are harder to read when there is an implant. This problem is minimized by taking special mammogram views called Eckland views, which show the breast tissue in multiple planes to "see around" the implant. It works very well but there still is a small (less than 10 per cent) amount of breast tissue that remains unseen. Mammograms work better when the implant is placed under the muscle. This allows better visualization.
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Height, Weight and Bra Size
Typically, your exam will begin with your height, weight, and bra size. You should be as accurate as possible. If you have been pregnant or have had a significant weight change be sure to let Dr. Cruise know. Tell him what size you would like to be. For example, "I am a 34 A and would like to be a 34 full C." While cup sizes are highly variable depending on manufacturer, this still gives Dr. Cruise an idea of what you are looking for.
Once again, a picture of someone with breasts that you like is helpful. Be sure that this person has a body type similar to yours. Point out what you like about the picture, "I like her size, I like her cleavage, I like her fullness up high, or her natural appearance," etc.
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Observation
The second part of the exam involves evaluating the breasts for size, shape, and symmetry. It should be pointed out that all breasts are asymmetrical. Some are extremely asymmetrical while others have only minimal differences. These asymmetries will persist postoperatively. Common causes of asymmetry include size differences, sagginess, nipple location, areola size and shape, scoliosis, and chest wall asymmetries.
- Palpation for masses
Typically, your plastic surgeon will perform a quick breast exam. Monthly self- exams are extremely important and are the best way to catch early cancers at a stage when they are easily treatable.
- Measurements
Dr. Cruise will take measurements. This helps to objectively determine what would best obtain your goal. Here are the most important measurements:
- Distance from sternal notch to nipple
This distance determines sagginess of the nipple. Normal distances are less than 21 to 22 cm. Over 22 cm usually means there is some component of sag. Minor sag can be corrected with augmentation but usually needs some type of breast lift in conjunction. See the section on Breast Lift for more information.
- Distance from nipple to inframammary fold (IMF)
This distance determines if there is a bottoming-out of the breast. It increases as the breast tissue falls downward. Typical lengths are less than 8 cm in the ideal breast but may be more in large breasts and still be acceptable.
- Relationship of nipple to IMF
This is, perhaps, the most important measurement. It determines whether the nipple is on top of the breast or has fallen. The ideal breast has a conical shape with the nipple on the top. The nipple should be at least 1 cm above the IMF. When the nipple falls below the IMF it should be lifted. Nipples that are at the same level as the IMF may be corrected by augmentation alone. This must be determined by your plastic surgeon.
- Width of breast
This measurement is important in determining the maximum size of an implant that will fit on the chest wall. This measurement can be anywhere from 11 cm to over 16 cm. If someone has a thin chest but desires a large augmentation, she may need to use a high-profile implant to accomplish this.
- Gap between breasts
This is the distance between the breasts. Most people relate it to cleavage but cleavage also is dependent on breast size. Typical separation is about 3 cm. This distance can be made smaller by elevating the pectoralis major muscle along its medial border. Point this out to your plastic surgeon if this is important to you.
- Areola size
The areola is the colored area around the nipple. It often enlarges after pregnancy as well as changes shape. Ideal areola size is subjective. Areola reduction is often done at the same time as breast lifting, but not routinely, with breast augmentation. Reduction requires a scar that goes all the way around the margin of the areola.