Part 1 - Breasts (published on 15 January 2021)
Why do postpartum mothers find it difficult to lose weight after pregnancies?
Dr. Lee: When mothers undergo pregnancies, it’s natural they put on weight but the problem is, mums often gain too much weight. Apart from that, hormonal changes play a role in weight gain too. After pregnancy and delivery, patients may also pack on the pounds because they are too tired to work out. Although I do admit that caring for babies is hard work albeit not physically demanding, mothers are often exhausted as they experience lack of sleep due to round the clock care and constant feedings. On top of that, mothers who follow strict confinement customs occasionally overeat because traditions call for excessive food consumption – one chicken per day! In summation, if mums are eating too much and are too mentally tired to exercise, fats deposits will indubitably accumulate.
Dr. Enrina: Expectant mothers go through a whirlwind of hormonal changes and this may cause increased caloric intake coupled with uninvited water retention. If mums have their hearts set on weight loss and stick to strict regimes, diet and exercise may just do the trick if postpartum mothers are able to set aside time to exercise and cook healthy meals.
What are the methods of liposuction?
Dr. Lee: First, we have traditional liposuction, which doesn’t utilise any form of additional energy to remove fats. Next, we have assisted liposuction where energies such as ultrasound, laser and mechanically assisted liposuction aid in improved fat removal. Ultrasound or laser-assisted liposuction work under the same principles where auxiliary heat energies help melt fats before the liposuction’s vacuum removes the melted adipose tissues. Power-assisted liposuction or mechanically assisted liposuction is a quick moving mechanical cannula, which extracts fats. All these methods are applicable to postpartum patients. In my practice, both laser- and ultrasound-assisted liposuction are available. Despite both producing favourable results, my favourite is still Vaser Liposelection (ultrasound) because laser-assisted methods are extremely slow and useless when tackling large volume liposuction. Therefore, I’ll only recommend laser-assisted liposuction to patients with smaller pockets of fat normally around the chin or arms. Should postpartum mothers desire liposuction of the tummy and thighs, it’s best they opt for ultrasound-assisted liposuction (Vaser Liposelection) as treatments are effective, fast and safe.
Dr. Enrina: Liposuction enables fat removal through utilisations of special instruments to improve bodily contours. Laser or ultrasound-assisted liposuction provides improved results because heat energies not only liquefy fat but also stimulates collagen to induce continuous skin tightening months after surgery. Although energy-assisted liposuction demands more surgical time due to fat liquefaction, patients will enjoy smoother results, improved dermal qualities and best of all, less pain.
Dr. Lee: I normally recommend patients wait six months after delivery before undergoing any form of surgery including liposuction. Because patients resume normal activity after a month after delivery, they typically lose significant amounts of weight whether from work or exercise. Thus, it’s not recommended that patients undergo liposuction immediately after delivery. Moreover, if patients repeatedly lose weight even after six months, I may recommend they continue shedding the kilos until weight has plateaued. Once this happens, we can move with the liposuction to remove stubborn fat.
What are the risks and complications related to postpartum liposuction?
Dr. Lee: There are no risk differences between postpartum mothers and normal patients. While this may be, patients will experience some levels of pain after surgery. As such, mothers must make arrangements with friends and family who can help out with childcare during mum’s recovery period.
Dr. Enrina: Risks and complications related to liposuction can include infection, bleeding, irregular contours, asymmetry and fat emboli. Like all procedures, risks of complications are drastically reduced when patients undergo surgery with certified surgeons who employ good equipment in accredited facilities. Patients who desire contoured physiques should wait three to six months after childbirth before undergoing liposuction. Moreover, mums should also conclude
breastfeeding beforehand because anaesthetic drugs, painkillers and antibiotics may remain in the bloodstream.
Why are tummy tucks a popular procedure?
Dr. Lee: During pregnancy some patients suffer overly distended tummies. Once tummies are distended, the rectus muscles on both sides will not only separate but lengthen as well. In addition, stretched skin that becomes loose will have difficulty bouncing back if mums experience increased fluid accumulation or if babies are large. Once patients experience separated, lengthened muscles with saggy skin, the tummy will appear shapeless, slack and droopy. Furthermore, patients will find eating embarrassing because separated rectus muscles will affect in bulging tummies even with the tiniest amounts of food. Patients who have put on weight on top of the separated rectus muscles and loose skin would obviously look much larger as well.
There are two types of tummy tucks – mini tummy tucks and full tummy tucks. Which type should postpartum mothers choose?
Dr. Lee: Chosen surgical forms will depend on the patient’s indications. If patients have separated rectus muscles in addition to loose skin, they will not be appropriate candidates for mini tummy tucks. Mini tummy tucks are only applicable to patients with small amounts of loose skin that hang below the belly button. Should they complain of bulging tummies, it’s best they undergo a full tummy tuck instead.
Dr. Enrina: Tummy tucks are a surgical procedure which aims to either tighten the abdominal walls plus reduce loose tissues or simply excising the loose skin alone. Because mini tummy tucks don’t require stitching of the rectus muscles, it’s less invasive and offers faster recovery periods with scars only limited to the bikini line. Full tummy tucks are more complicated and therefore require increased surgical time with hospital admittance of at least one night. Patients will sometimes be subjected to drain placements and will undergo increased recovery periods of at least a week.
How are full tummy tucks carried out?
Dr. Lee: Full tummy tucks are normally conducted under general anaesthetic. After an incision is made, stitches are placed on the rectus muscles to mend the separation. Later, we will address the loose skin by pulling the excess tissues down, excising all the skin below the belly button and the pubic bone and stitching it up. Because entire chunks of loose skin have been pulled and cut, the patient will lose her original belly button and a new one will be created.
What are the risks and complications related to postpartum tummy tucks?
Dr. Enrina: Full tummy tucks risks include infection, bleeding and deep vein thrombosis caused by increased surgical time. Patients may also complain of hypertrophic or keloidal scars and fluid accumulation under the skin. I can’t stress this enough: Always consult with experienced plastic surgeons with accredited facilities if you desire good outcomes that pose little to no threats of risk and complication. Postpartum mothers should wait six months before undergoing tummy tucks as internal organs have returned to their original size by then, and C-section scars have already matured. However, mums have to bear in mind the long recovery period as drugs, medication and limited movement may affect breastfeeding and childcare.
What advice would you give to postpartum mothers who want to undergo plastic surgery?
Dr. Lee: The first thing mums have to consider is how the baby will be cared for during their recovery period. Before undergoing surgery, significant preparation will be required. Since mums need significant rest after procedures, they should recruit help especially because babies or young children need constant looking after. In addition, mums have to be psychologically prepared as it’s not easy to listen to babies cry and not have the ability to pick them up or tend to their needs due to pain. Generally, recovery periods for all listed surgeries will take about two weeks. Therefore, patients should have husbands, friends and family on hand to aid in childcare during this short period.