Mommy Makeover - Breasts (Part 1 of 3)

Cosmetic Surgery & Beauty Magazine finds out how mothers get back to their old selves (or better) with a little help from their plastic surgeons. Part 2 - Liposuction (on 17 Jan 2021 - 11:00am) Part 3 - Tummy Tuck (on 19 Jan2021 - 11:00am)

Cosmetic Surgery & Beauty Magazine - January 15, 10:02 AM

Pregnancy is physically demanding and results in drastic bodily changes in short amounts of time. To accommodate your growing fetus, mum’s body makes unprecedented adjustments and once this happens, it’s extremely difficult to reverse the effects even if mums stick to strict diet and exercise regimes. A little nip and tuck, however, can help you slip into that bodycon dress of yesteryear. Consultant Plastic and Reconstructive Surgeons, Dr. Lee Kim Siea and Dr. Enrina Diah shed light on postpartum plastic surgery. 


Why are breast augmentations and breast lifts popular among postpartum mothers?
Dr. Lee: After mothers have given birth, the breasts will suffer distention where fat atrophy and stretched skin occurs. Bigger breasted patients that have undergone an engorgement in preparation for breastfeeding will also experience extensive mammary deflation and sagging after breastfeeding. When patients experience deflation, they will normally find ‘empty breast’ syndrome on the upper pole as opposed to the lower half of the breasts because once the skin stretches to a certain point, it’ll be difficult for the body to naturally recover. The choice between a breast augmentation and a mastopexy (breast lift) will depend on the patient’s indications. If the mother’s breasts have lost fullness with nipples maintaining their height – above the inframammary fold – then, simple breast augmentations will suffice. Conversely, if there’s significant ptosis where nipples droop below inframammary folds, sole augmentations will be unfavourable, as nipples will continue to point downwards. When there is substantial drooping, I recommend breast lifts where surgeons remove loose skin and elevate the nipple above the inframammary fold. Patients will enjoy restored breasts as well as larger looking ones. There are cases where patients undergo breast lifts in conjunction with augmentations but this is only applicable to those who suffer both deflated and droopy breasts. 
 Dr. Enrina: Breast augmentations aim to restore volume. This is achieved through autologous fat transfer or implants. Despite the latter being a more popular procedure due to improved predictability and enduring results, fat transfer is effective as well since postpartum mums exhibit enlarged breast pockets with copious amounts of fat deposit. If done well, postpartum mothers should demonstrate better outcomes when compared against patients with no children. Breast augmentations have the ability to restore volume with minimal scarring – usually hidden under the breasts – but doctors should firstly evaluate breast laxity, nipple positions and thickness of breast tissue before deciding on specific procedures. Should there be signs of significant laxity and drooping of the areolar complex, concomitant breast lifts should be considered. Modern mastopexy techniques normally employ the vertical lollipop sac technique, which limits scars to vertical lines. 
Photo courtesy of Dr. Enrina Diah
What do you recommend to postpartum mothers who choose to undergo augmentations?
Dr. Lee: Although I’ve stated that patients normally lose volume in the upper portion of the breasts, I can recommend both round and anatomical (teardrop implants) or fat grafting based on patients’ needs. There are some patients who prefer anatomical implants because they find overly full chests unaesthetic. There are also patients who haven’t lost too much volume on the upper pole of the breasts. In such instances, anatomical implants will provide good results. Of course, if patients lose volume in the upper region of the breasts, round implants or fat grafting will offer better outcomes. However, if patients desire a significant increase in breast size, then implant augmentations would be a better choice. Should patients lose volume but still prefer smaller sizes, good surgical outcomes may be impeded as amplified loose skin will call for bigger implants. If such cases arise, surgeons may recommend an additional procedure, which calls for skin reduction in conjunction with the augmentation.
There are multiple implantation routes surgeons can take – through the armpit or nipple and under the inframammary fold. If patients are breastfeeding, I would avoid surgeries through the nipple, as surgeons may cut the milk ducts. In my opinion, the best implantation route is through the inframammary fold. Should patients need an additional mastopexy, we can place the implant through the inframammary incision to avoid additional scars. 
What do you recommend to postpartum mothers who choose to undergo mastopexies?
Dr. Lee: Surgical differences will depend on how saggy the nipple is. If sagging is mild, we can just cut around the areolar, excise skin and close the incisions. If sagging is prominent, we will have to cut around the areolar and bring the cut down to the inframammary fold. Should patients exhibit highly droopy breasts and need lifts in conjunction with augmentations, risks are invariably higher. As such, I will recommend staged procedures where mastopexies are conducted first and augmentation only carried out after three months. 
What are the risks and complications related to postpartum augmentations and breast lifts?
Dr. Lee: One of the greatest complications of postpartum augmentations is the presence of milk in the breasts. If nipples aren’t sufficiently sealed, leaked milk can come into contact with the implant and this can lead to infection, seroma and capsular contracture as bacteria is present. In response, surgeons will have to protect the nipple during dissection to ensure that milk doesn’t leak. This is why it’s also not recommended for postpartum mothers to choose the periareolar route as we may cut through the milk ducts when implants are placed. On top of choosing the right routes, I recommend that patients wait six months after breastfeeding before undergoing surgery as most of the milk would have dissipated by then. Despite this, there have been instances where milk was still present even after the recommended timeframe. In terms of breast lifts like augmentations, surgeries may cause trauma to the milk ducts as well. Ergo, I normally recommend that patients only undergo breast lifts after they have concluded all pregnancies. 
 Dr. Enrina: If surgeries are carried out at the appropriate time, complications and risks should be no different to those who have not undergone pregnancies. However, if postpartum mothers choose to undertake augmentations in conjunction with lifts, there will be increased risks of wound disruption, enlarged areolas, asymmetry and deformities. Hence, it’s imperative that patients seek experienced surgeons when desiring to go under the knife. Swelling and pain usually peaks during the first three to five days post surgery and will begin to dwindle after this period. Patients may resume normal activity after a week depending on individual conditions. 

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