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I was recently interviewed again by the Southern Marin Mother’s Club for their ongoing series of articles, Feeling Good, Looking Good.  In previous interviews I spoke about the cosmetic side of the Mommy Makeover. In the article below, I discuss medical procedures that are often necessary after pregnancy.  These procedures can often be performed in conjunction with cosmetic procedures.

This article appeared in the Southern Marin Mother’s Club newsletter.

More information on the Southern Marin Mother’s Club can be found at www.southernmarinmoms.com

Dr. Carolyn Chang, San Francisco Plastic Surgeon

Feeling Good Looking Good

Medically Necessary Mommy Makeovers

Can you have your cake and eat it too? I spoke with San Francisco Mommy Makeover specialist Dr. Carolyn Chang about the growing trend of combining necessary medical procedures with elective cosmetic surgery in order to achieve the “ultimate” in mommy makeovers.  As we know, pregnancy takes its toll on you physical appearance.  It unfortunately, can also take its toll on your body from a medical perspective.  Some of the least discussed medical issues that can arise after pregnancy include the appearance of abdominal and umbilical hernias, and urinary incontinence and urgency.  These conditions can seriously interfere with your quality of life and in some case, even be detrimental to your health.  As women are more open with their physicians, these problems are being discussed.  Surgical options are often the only solution, and more and more moms are asking to have the procedures that they need performed in conjunction with the elective cosmetic surgeries that they want.  I also spoke to Dr. Michelle Li, a General Surgeon, and Dr. Alexandra Haessler, an OB/GYN to help better understand the medical procedures themselves.

What combination procedures are you seeing most?

Dr. Chang: The overwhelming majority of my combination requests involve combining a tummy tuck with either a hernia repair or some sort of gynecological procedure.  The hernias usually became prominent after pregnancy and are most often located at the belly button or in the anterior abdominal wall.  Gynecological procedures can include a wide variety of medical conditions that need to be treated.  Common ones include procedures for incontinence after surgery, fibroid or polyp removals, tubal ligations, and hysterectomies.  Certainly breast procedures and liposuction can also be performed in conjunction with the treatment for these medically necessary conditions.

How are pregnancy-related hernias repaired?

Dr. Li: A hernia is a protrusion of any tissue or organ outside of where it normally lies.  Hernias tend to occur at areas of natural weakness, and may be caused by increased pressure or tension on those areas.  In pregnancy, the persistent and increasing pressure on the abdominal wall as the fetus grows can cause stretching at those weakened areas.  A hernia will become evident when it becomes large enough that tissue or organs can fall through it and often appear as a persistent “bulge”.  This is most often located in the groin or in the belly button.

Simple post-partum hernias are treated by bringing together and reinforcing the tissues of the abdominal wall that have separated, preventing the organs within the abdomen from “spilling through.”  The hernia repair will fix the abnormal bulge, but will not usually significantly restore the contour of the entire abdominal wall, and for that reason, many women elect to undergo a tummy tuck at the same time.

As a rule, most hernia repairs that occur during pregnancy are deferred until after delivery.  If, however, the bowel becomes entrapped in the hernia, the woman may feel pain, nausea, and bloating.  If this becomes the case, prompt surgical intervention is necessary.

What can be done for women who are experiencing urinary incontinence and urgency after childbirth?

Dr. Haessler: Pregnancy and childbirth may be associated with trauma to the pelvic area and can involve muscular, connective tissue, or nerve injury, which is often undetected by the patient.  These factors may contribute to weakening of the tissue that supports the pelvic organs.  When the pelvic organs are not well supported they often do not function properly.  Symptoms of pelvic floor dysfunction can include new urinary urgency, incontinence or incomplete bladder emptying.  Occasionally, the vaginal walls protrude into or outside of the vagina causing an uncomfortable pressure or bulge.  Other conditions may occur, such as a gaping of the vaginal opening or problems with defecation.  If a woman develops these symptoms after a birth, she may be suffering from such a condition. These conditions are rarely dangerous; however they can interfere with sexual function and significantly impact a woman’s quality of life.

Typically, if the symptoms do not improve with time and pelvic floor strengthening exercises, several minimally invasive surgical procedures are available to resolve the problem.  The most common procedure is designed to treat urinary incontinence that occurs during exertion, such as exercise or coughing.  It involves placement of a small sling between the vagina and urethra. In this case, the support under the urethra is restored.  After the surgery, most women report they are able to resume a full range of exercise and activities while remaining dry.  They often wonder why they had not had the surgery earlier.

These procedures are typically short in duration and thus are very safe to be performed in conjunction with other procedures such as a tummy tuck.

What are the advantages and disadvantages of the combination surgery approach?

Dr. Chang: The main advantage for busy moms is minimizing recovery time.  One recovery allows for maximal results with the least time away from the family.  The other advantage, of course, is that she is able to have the cosmetic procedure that she wants with the procedure that she needs, and that makes having surgery much more palatable. It’s like a gift with purchase!  And finally, there can be some financial benefit to combing procedures.  Although the cosmetic portion is never covered by insurance, depending upon the insurance plan, some of the hospital charges and anesthesia costs for the cosmetic portion can be subsidized by the medically necessary portion.   A word of caution, however, is that the savings may not be as significant as one would think due to the constraints of insurance plans and hospital billing practices.  But in the end, every little bit does help.

The main disadvantage to combining procedures is that the recovery may be a little more extensive than if only one of the procedures was performed.  In my experience, however, I have found that this extra time for recovery and discomfort has been relatively minor and short lived, and that overall recovery time is still much shorter for a combination procedure.

How do I know if I am a candidate for a combination surgery?
Just ask! Your physician will be able to guide you as to the safety and feasibility of combining procedures.  He or she can also provide you with references for surgeons that can perform the desired procedures.

Posted by Dr. Carolyn Chang San Francisco Plastic Surgeon