Dr. Dennis Hurwitz can perform a mommy makeover procedure that improves body contours after pregnancy, childbirth, and breastfeeding. This video illustrates the transformation of one 35-year-old patient. Following her procedure, she has a more toned midsection, fuller and perkier breasts, and a smaller backside.
Our mommy is 35 years old, 5'5", 155 pounds and she desires mastopexy with augmentation, abdominoplasty, and liposuction of the hips, waist and epigastrium. The operation starts with the mastopexy, a periareolar de-epithelialization is performed with areola, 42 millimeters in diameter. To reach the space for the implant, I like to cauterize these sections taken through the inferior areolar region, and then sharp dissection continues directly perpendicular to the chest wall, through the parenchyma of the breast.
Once we reach that point, electrocautery dissection elevates the space for the implant under the subpectoral fascia. A gel implant 375 cc is easily placed to this incision. The incision is closed in two layers, using absorbable sutures to maintain the vertical projection of the breast by a perpendicular closure, as was the entry. The periareolar tissue will be incised with electrocautery so that there is a round circle, outer ring to the areola, and some minimal undermining to minimize the puckering. A towel clip begins the approximation with a quill.
The abdominoplasty upper incision has been made, midline undermining followed by the discontinuous dissector of LaRue. After it's been determined that the superior flap can reach the pubic area, the umbilicus is cut out and isolated. The inferior incision is next and continues down to Scarpa's fascia with care to preserve the underlying lymphatic system. Electrocautery removal of this excess skin between the umbilicus and pubis is done with the preservation of the areolar tissue over the oblique musculature. The midline rectus muscle and linea alba is exposed, but the perimeter tissues have areolar tissue. The size flap is seen. Midline imbrication of the lower abdomen is done, as had been performed, the upper abdomen, using #2 PDO quill sutures, placed in a horizontal mattress fashion.
The continuation of the flank liposuction is done simultaneously by one of my assistants at the same time. The horizontal mattress suture is then followed by a J return of an over and over running stitch of the #2 quill PDO. I have found this to be adequate and long-lasting. With the table flexed, and the beginning of the umbilicoplasty performed, the closure of the subcutaneous layer is performed with a #2 PDO quill measuring 72 centimeters in length on a 48-millimeter half circle tapered needle. We begin superficial to deep, and then come out deep, return to deep, and then superficial. After two throughs from midline, we pull apart the sutures to cinch. My assistant and I are then suturing the abdominoplasty flap down to the groin. It is easy with the running #2 quill to gather the longer upper incision flap to approximate to the shorter thigh and groin region.
Once reaching the end and to avoid a dog-ear, we are doing a horizontal mattress suture. While that is being completed, the umbilicoplasty skin approximation is done. The final layer is with #30 monoderm intracuticular sutures. Two drains are placed through the pubic region.
Post-operative care revolves around pain management and smoothing out the tissues, removing excess edema using endermologie three or four times a week in the first few days after surgery. The post-operative results, at one month, we could see the removal of the excess tissue, the sculpturing of the abdomen, the improved breast projection and fullness, the narrowness of the waist, the relative smallness of her buttocks, and now a symmetrical appearance, but there's still some time for the swelling to reveal the complete mommy makeover.