Dear Dr. Kim: Should I Have My Muscles Stitched Together During My Tummy Tuck?

Dr. Kim opens up his mail bag to answer more patient questions. This week, a thin woman with a flat stomach but lots of excess skin from childbirth wants to know if she should just have her skin tightened with a tummy tuck or if she should also have her abdominal muscles stitched together.

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Mommy Makeover - 3 Secrets to a Faster Recovery

A Mommy Makeover is a popular cosmetic surgical rejuvenation to help women reclaim their bodies after having children.  It can include a breast augmentation, a breast lift, liposuction, a tummy tuck or any combination thereof.  After 14 years in private plastic surgery practice in San Francisco, here are some little known secrets that have helped my Bay Area patients and will certainly help to speed up your recovery, too.

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How to Help Your Wife After a Mommy Makeover

Your woman has done a lot for you.  And you know what they say about paybacks, right?  As a husband, domestic partner or significant other, you will be charged with taking care of your lady after her Mommy Makeover.  This is a large responsibility in terms of emotional, psychological, and physical support, so here are some hints to help you take care of your awesome wife.

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6 Things Patients Wish They Knew Before a Mommy Makeover

A Mommy Makeover is an overall rejuvenation to help women reclaim their bodies after having children.  It can include a breast augmentation, a breast lift, liposuction, a tummy tuck or any combination thereof.  After 13 years in private plastic surgery practice, here are a few morsels of advice from my patients to you.

1) All About Cup Size?  Not Exactly.

Despite the fact that breast augmentation is the most common plastic surgery procedure, most women are surprised to learn that implants come in a variety of sizes and profiles

Patients know that cup measurements are imprecise and are pretty familiar with volume measurements like 300cc, 400cc, etc.  But the real key to getting perfect looking breasts for your body is to choose the appropriate profile.

Implant profiles are categorized into low, medium and high profile and refer to both the height and the width of the implant.  I will measure your chest and your body to help you pick the correct volume and profile.  If the profile is too low for you, your breasts may appear too far apart and won’t provide the proper cleavage.  Conversely, choosing a profile that is too high for you will result in a condition called ??? (please insert, can’t find that word, but I know I’ve read it on your blog somewhere) where your breasts are actually touching and creating an unnatural look.

So it’s all about size and profile.  Now you know.

2) Pain Control is Possible Without (or With Less) Drugs

Too many women simply reach for the pill bottle after surgery.  And who can blame them?  This is the only option that many doctors give their patients for pain control after surgery.  But, psssst.  My patients have a secret for you.

Not used by all plastic surgeons (although I have no idea why not), most of my patients are sent home with a pain pump.  This is a wonderful little ball that is filled with numbing medication.  Two small tubes run from the ball to the areas of your incisions and newly formed “breast pockets” to deliver a continuous stream of medicine.  The pain pump greatly reduces and sometimes even eliminates the need for oral narcotics, which have side effects as mild as constipation and as severe as addiction.  Plus, because the medicine is delivered only to the area of pain and not throughout your entire body, you’ll feel better faster.  You’re welcome.

3) Keep It Movin’. But Not Too Much.

Moms are so used to taking care of everyone and everything that one of the hardest parts of recovery is to simply – recover.  Resist the urge to move around too much while trying to catch up on laundry, cooking, cleaning, nose wiping, toy gathering, etc.  Your recovery should be the #1 priority in the few weeks following your surgery.  Enlist some help, and even though it might not get done in the way you would do it, it will get done…eventually.

Meanwhile, even though it smarts a little bit, be sure to keep moving your arms around and making an effort to get out of bed to walk around for a few minutes each day.  This will help you recover, too.  Just don’t let the kids see you out of bed.  You know how quickly that can turn into a free for all!

4)  OMG. I’m Pamela Anderson.

Relax.  It’s just the swelling. Your breasts will continue to drop into a more natural position with time, and the swelling will continue to decrease for many months.  But, yeah, that first look after taking off the compression bandages?  Whoa.

5)  Crazy Train

Recovering after surgery can be an emotional experience. Fatigue combined with narcotic pain pills have many women feeling like they jumped aboard the Bi-Polar Express.  Elation.  Tears.  Laughter.  Anger.  And that’s just in 5 minutes!  If you're on Vicodin or Codeine, you may feel loopy, flaky, sleepy, out of it and constipated.  Sounds fun, right?  If your pain pump can control your pain, or at least most of your pain, you'll feel more awake, more normal, and still not be in that much pain.

6) Go Big or Go Home.  Well, At Least Go a Little Bigger.

The number one complaint that I hear from women after surgery and what most of your girlfriends will tell you if you ask them is that they wish they had chosen slightly larger implants.  First, implants will actually appear a little smaller inside of your body, because they are placed under the muscle.  Compression from the muscle causes perhaps 3-5% shrinkage.

Second, and this is very psychological, most women wish they had a bigger volume size after their breast augmentation.  Once they get used to the idea of larger breasts, which often happens only after surgery, they wish they had gone slightly larger.  To prevent this from happening, I recommend you choose a size that's a little too big, but that you can live with, typically about 25-30 cc larger than what you're trying on in the office.

So there.  From many women to you, those are the secrets to know before a Mommy Makeover.  If you would like to schedule a consultation, contact my Patient Care Coodinator, Caroline, at info@drkim.com or 415-362-1846.

Recovering from a Mommy Makeover

Mommy Makeover Before and After Pictures

Most women who take the big step to reclaim their bodies after having children tell me that it’s the best money they have ever spent. By rejuvenating their breasts, tummies, hips and thighs, my Mommy Makeover patients can finally free their heads from that annoying little voice that constantly reminds them of their “problem” areas. Besides, don’t moms have enough little voices in their heads already?

Looking at Mommy Makeover before and after photos can help you know what kind of results to expect, including understanding the post surgical scars and how I minimize the visibility of tummy tuck and breast surgery scars.

Click here to visit my Mommy Makeover pictures - http://drkim.com/before-after-gallery/body-makeover-photos.html/

Preparing for Your Mommy Makeover

Remember back when you had your first baby? While waiting to go into labor you likely used a check list to get all ready for the big day. After the baby came home, check lists and “to do’s” went out the window, and you were on your own! Well, we know moms can use all the help they can get, and this is even truer as you prepare for and recover from your Mommy Makeover surgery.

Here is a handy check list of things to buy/do/arrange for BEFORE your big day:

_____ Choose books/magazines to read

_____ Get DVDs to watch

_____ Set up laptop computer near the bed

_____ Buy groceries to last at least 1 week (healthy, high in protein)

_____ Fill prescriptions for antibiotics and pain medications

_____ Buy ice packs to reduce swelling

_____ Set up nightstand with snacks, bottled water, remote controls for entertainment

_____ Put extra sheets, pillows and towels near the bed

_____ Get extra surgical dressings

_____ Arrange for pet care

_____ Arrange for child care

_____ Secure companion to drive you home and stay with you for 1-2 days post surgery

Recovering from a Mommy Makeover

The most common mistake that busy moms make after undergoing a Mommy Makeover is trying to do too much too soon. It is very tempting to step back into the role of care giver, especially in those first few days after surgery. You often feel fairly good after coming home because of the pain medications used during your surgery. Do not make this mistake! Taking the time to properly recover from your Mommy Makeover is just as important as the surgery itself. You’ll feel better faster if you take the time to properly recover from your Mommy Makeover.

You will need consistent help at home for the first 2-3 days to make sure you take your pain medications, stay hydrated and have help getting in and out of bed or to the restroom. You may choose to recover for a day or two at a post-op recovery facility. These are like hotels that specialize in post cosmetic surgery care that can offer you experience and comfort that well-meaning family and friends may not have.

Drains will likely be placed in your incisions after surgery and measuring the output of fluid helps your surgeon to determine when to remove the drains. You may also go home with a pain pump, which is a magical ball that reduces pain by delivering numbing medication directly to your surgical area.

You should spend the next 3-5 days at your house with a caregiver who can help with meal preparation, cleaning, etc. Allow for a full 7-14 days before returning to non-strenuous work and longer if you happen to be an aerobics instructor or carpenter.

You should be fully “recovered” after 14 days but you may still be bruised, swollen and stiff after two weeks. Be sure to plan your calendar for travel, special events and work accordingly. Finally, after all of that preparation and recovery, you have just one thing left to do … enjoy your new body!

If you'd like more information on a Mommy Makeover, please contact my Patient Coordinator, Caroline. She can be reached at 415 362 1846 or info@drkim.com. We look forward to meeting you!

Dear Dr. Kim - San Francisco Mommy Makeover Questions Answered

Even though I'm cute, it's my fault

We’ve all seen the sweet Johnson & Johnson commercials where a mother lovingly stares down at her new child and the tag line says, “Having a baby changes everything.”  What those commercials don’t show is the woman later staring at herself in the mirror and saying, “Having a baby changes everything!”

Women who come to me for consultations and/or surgeries after having children, whether they gave birth 2 years or 20 years ago, have one resounding complaint - they want their bodies back. A Mommy Makeover is a popular term that describes a surgical procedure to do just that.  Because every patient is unique in their post-baby aesthetic needs, a Mommy Makeover is a general phrase to mean anything from breast augmentation to liposuction to a breast lift to a tummy tuck or any combination thereof.

Moms are used to answering lots of questions (Why is the sky blue?  Why can’t I see the wind? Who invented God?), but today I’m going to let the moms do the asking.  Here are the questions I most often get from San Francisco and Bay Area moms who are considering a Mommy Makeover:

Why does my stomach still look like this despite diet and exercise?  Will a Mommy Makeover help it to go back to normal?

The rectus abdominis muscles are muscles that go up and down, next to the belly button.  The are often called the “six pack” muscles. When you’re born, these muscles are next to each other, and meet in the middle of your tummy. During pregnancy, these muscles separate as your belly grows.  If you lay flat on your back and do an abdominal “crunch” while looking at your stomach, you may notice that your tummy makes a tent shape as you flex. This slight separation is called a diastasis.

If you are relatively fit and thin, and you still have loose tummy skin and loose abdominal muscles in that area, then you may need a tummy tuck to tighten your rectus abdominis muscles.  During your tummy tuck operation, the right and left rectus abdominis muscles are sutured together, resulting in putting the muscles back into their original positions.

How long is the recovery time for a Mommy Makeover?

I know that moms are the busiest people on earth.  But you’ll feel better faster if you take the time to properly recover from your Mommy Makeover.

For the first 2-3 days, you will need consistent help and care to make sure that you stay hydrated, stay on top of your pain medication schedule, and have help getting in and out of bed, etc.  A good option is to reserve a room at a post-op care facility.  We use the effective if not creatively named Post-Op Recovery Place (www.postoprecoveryplace.com).  These types of facilities have the experience to help you during your recovery, which your well-meaning family and friends may not have.

You should spend the next 3-5 days in a hotel or at your house with a caregiver, like your sister/ husband/ nurse/ best friend/ cabana boy from Miami.  Plan on a staying home for a full 7 -14 days before returning to an office job, longer for more physical jobs.

Be sure to go grocery shopping, pick up your pain medications at the pharmacy, arrange for help with the kids, get lots of good books, and rent some “chick flicks” before your procedure so that you are all set when you get home.  A diet rich in protein will help you heal faster.

How can I reduce pain and recovery time after my Mommy Makeover?

Typically, the more procedures you have done, the greater your recovery time and pain.  But there are several things that I do to greatly reduce both.

1. Reducing Drain Time - When most plastic surgeons close the tummy tuck, they just close the skin edges, and insert a drain, and let the drain work for 5-8 days.  I actually use a technique to suture the tummy tuck tissue to the underlying abdominal wall muscles.  This allows much less friction between the skin and the tummy muscles, resulting in less seroma fluid/ less post-surgery fluid, and less pain.  It also means your drain doesn’t stay in as long.  I can usually remove it in 1-2 days.

1. Out Patient Surgery-  Most tummy tucks are done in a hospital setting, at least in San Francisco.  The only reason is that conservative surgeons are concerned about pain control after surgery.  I use a pain pump, which I’ll explain below, but this allows my patients to have an “out patient surgery” procedure.  You come in, have your procedure, and go home/ to the hotel room.  This reduces the risk of hospital based infection, and most people seem to want to recover in their own home, or in a hotel room, as opposed to a room with a new roommate in a hospital.  Obviously, most patients who want a tummy tuck are younger, so there’s no medical reason to undergo surgery in a hospital setting for medical illness concerns, like high blood pressure, heart disease, etc.  Rather, it’s done in a hospital for post-op pain control.

1. Pain Pump – This is a truly awesome medical device, and my patients love it.  It has a long catheter (a very tiny, thin, long tube) attached to empty ball.  The ball or pain pump is filled with numbing medicine.  The numbing medicine slowly leaks out of the end of the long tube.  During your operation, I place the tiny long tube in the area of surgery.  This allows numbing medicine to be slowly dispensed in the area of maximal surgery and maximal pain.  The numbing medicine acts to numb the area of tummy muscle tightening and under the long tummy tuck incision.  You’ll still need pain medications by mouth, but a lot fewer pills for a shorter period of time.  The numbing medicine is dispensed by the pain pump for 3-5 days, depending on how big the ball is.

How much does a Mommy Makeover cost in San Francisco?

This is a difficult question to answer because obviously the more procedures you have, the more it will cost.  For a typical Mommy Makeover in San Francisco that includes a breast lift with augmentation, a tummy tuck, and some moderate liposuction, patients can expect to pay around $20,000.  This includes the surgeon’s fee, operating room fee, and anesthesia fee.  Generally, post-surgery visits are free.

If a mom just needs some liposuction in the tummy area, depending on how much fat there is, and if it’s done in the office or operating room, expect to pay anywhere from $1000 - $4000.  It costs less in the office, but a lot of patients get too nervous.  If you’re too nervous, then I need to give you sedation medicine, which means that I need to do the procedure in the operating room to monitor you, which drives up the cost.

If you’d like more information on a Mommy Makeover in San Francisco, or would like more information, please contact Caroline, our Patient Care Coordinator. She can be reached at info@drkim.com or 415-362-1846.

What is the Post Surgery Care After a Mommy Makeover?

A Mommy Makeover is a large plastic surgery procedure, usually involving breast enhancement surgery along with a tummy tuck. The combination of both procedures helps many women rejuvenate their bodies and boost self-confidence. Since it’s a larger procedure, it’s important to have realistic expectation and prepare for the after surgery care needed to get the best results and return to work and your life as soon as possible.

Before surgery, make sure you have plenty of ice for ice packs, and have a functional remote control for your TV and DVD player. You should consider getting plenty of books and DVD’s to watch, since you won’t be able to move around in your normal fashion right after your surgery. A laptop computer may also be helpful, since you can surf the internet while you’re recovering from surgery.

Go grocery shopping and stock your house with your favorite healthy foods. You may not be able to drive for several weeks, due to discomfort and the fact that you’re on strong narcotics after surgery. Extra protein may help with recovery, since your body will want to heal as quickly as possible, which may require more protein than you normally eat.

Make sure to fill your prescriptions for antibiotics and pain medications before your procedure. They should be with you at the time of surgery, or waiting for you at home. Your bed should also be prepared for your comfort after your operation, including extra sheets, pillows, and towels to soak up any excess post-surgical fluid. If you need extra dressings, you can get some from your pharmacy or from your plastic surgeon.

You will be spending a lot of time in bed, so arranging your bedroom and nightstand with the proper medications, snacks, water bottle, entertainment options, pillows, blankets, towels and other accessories is key to feeling secure and safe after your Mommy Makeover.

In general, you will want to make plans for help at your home right after surgery. You may find it difficult to move around easily, and preparing meals, going to the bathroom, and even taking your post-surgery medications may be difficult without some help.

You will probably go home with drains that are placed after surgery, so measuring the output helps to determine when your surgeon can remove those drains.

If you go home with a pain pump, you will love your new best friend. Make sure it’s functioning, and your plastic surgeon may remove it, or may give you instructions on how to remove it, after it’s completely empty.

If you have young children, you may want consistent extra help at home so that they will be taken care of and not too bored while you recover from your procedure. A family member or friend may be able to help take care of them for 1-2 weeks after your surgery.

Your Mommy Makeover will take about 10-14 days after surgery to recover, and you will still be stiff after 2 weeks. Make sure you plan for trips, family events, and work accordingly.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

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What is the Recovery Like After a Mommy Makeover?

A Mommy Makeover is a large operation involving the abdomen and upper body. The abdomen usually undergoes a tummy tuck and some bilateral flank liposuction to reduce and eliminate the loose skin that may be associated after childbirth. The breasts often undergo a breast augmentation, breast lift or a combination breast augmentation and lift to give a more youthful and aesthetically appealing appearance to the breasts. Both operations can usually be done at the same time. In many women, a Mommy Makeover is a powerful, confidence building operation.

Recovery after a Mommy Makeover is variable, but typically takes about 10-14 days. The more procedures you have, the longer recovery time may be required. For example, if you need just a tummy tuck, your recovery will be faster than if you have a tummy tuck and liposuction. Another example would be if you had just a breast augmentation, you should have a slightly faster recovery compared to a breast augmentation with a breast lift.

A Mommy Makeover is typically done in a surgery center or hospital setting. Depending on your overall health and the amount of surgery you need, you may have to stay overnight in a hospital. After you go home, you will still need someone to help take care of you for 1-5 days afterwards.

After your procedure, drinking plenty of fluid and walking around a little will help mobilize your fluids and help with recovery. Hopefully your surgeon uses a pain pump, which dispenses numbing medicine automatically to the areas of surgery. This will reduce your pain levels and increase mobility as well.

If you have children, you should make sure that you have extra help taking care of them right after your Mommy Makeover. You should be able to walk around gently several days after your procedure, but everyone is different, and having extra help at home will psychologically give you a little less stress.

Returning to work will take 10-14 days, and you should be able to return to an office job sooner than if you have a more active job. Driving should also be possible within 2 weeks, but you should be off of pain pills before you drive.

Should you desire more information about my available services, or want to schedule an appointment, please contact my Patient Care Coordinator at info@drkim.com, or call our office at 415-362-1846.

Do you have any questions about Mommy Makeovers? Have any comments? Please feel free to leave some below.