When Lisa Brock, of Lebanon, Pa., decided to get a breast lift and augmentation one year after delivering her fourth child, she had no idea she was embarking on phase one of her "mommy makeover." She just knew she wanted her old breasts back.
"Before children, I was a full C cup," she says. "After breastfeeding all four kids, I was less than an A. I was a board. I just hung. Even my mother said she'd never seen anyone that needed surgery more than me."
Even though Brock was only 29 at the time, she had the surgery and was thrilled with the result. Now, the licensed practical nurse, who is 31, has just gone back for more. This time, she had a tummy tuck.
"God forbid I should have lifted up my shirt and let someone see that bump," she says, referring to her sagging stomach, which eight months of steady dieting and daily workouts had done nothing to cure. "It's not fat. It's just loose skin that I have no control over."
While it's difficult to come by exact numbers for mommy makeovers because it's a marketing term, not a surgical one, Douglas Mackenzie, MD, a board-certified plastic surgeon in Santa Barbara, Calif., says that mothers are by far his largest demographic. He attributes the trend to our obsession with youth as well as the public's acceptance of plastic surgery. Even the numerous television makeover shows, he says, are merely an indication of a boom that began awhile back.
"Unlike our parents generation, [these mothers] want to stay young and feel young, and preserve the body they've had," he says. "The music they listen to, the restaurants they go to, the clothes they wear, all have a lot to do with it. It's a new generation."
According to the American Society of Plastic Surgery (ASPS), 36% of the 9.9 million surgical and minimally-invasive cosmetic procedures performed in 2006 were on patients between the ages of 30 and 39; 29% of them were aged 20 to 29.
Breast augmentations increased 55% from 2000 to 2006, going from 212,500 procedures to 329,326. Breast lifts -- another favorite among the mommy makeover crowd -- went up 96% during the past six years, with the total number of procedures going from 52,836 to 103,788. Tummy tucks jumped a whopping 4,384% and buttock lifts increased 174%.
Even cosmetic genitoplasty, which often includes modification of the labia minora or labia majora, has come into vogue.
Laurie Casas, MD, a board-certified plastic surgeon and the co-author of a textbook on cosmetic breast augmentation, insists that while plastic surgery patients may be getting younger on the whole, postpartum plastic surgery for mothers isn't new.
"Breast augmentation was very popular during the 1970s and 1980s," she says. "They called it 'restoration of the breasts due to postpartum changes,' and it was done very, very quietly, and insurance paid for it. From 1991 to 2003, there was a hiatus because women were scared that implants were unsafe, so they wanted to see the science. After that, it became safe again, which is why we're seeing [the upswing]."
Jennifer Malone, 32, is one of those moms. Three months ago, the Jefferson, Ga., real estate agent opted for the postpartum plastic surgery trifecta: tummy tuck; breast lift plus augmentation; and liposuction on her legs, arms, stomach, and lower back.
Later this year, Malone, who has three school-age children, also plans to take advantage of the free liposuction "touch-ups" included in the package.
"I can't wait," she says. "And if the boobs start resagging, she'll relift them for free, too."
Costs and Complications
Those changes didn't come without pain, however. While serious complications and death are infrequent, pain from the procedures can be severe, especially in the first several days after surgery.
"I was prepared for the worst, but I was off the narcotics in three days," says Malone. "The first 24 hours is, by far, the most awful time of your life, though. It was pure hell."
Still, Malone says her recovery period was surprisingly easy, and her scars are rapidly disappearing. Brock was also amazed at how quickly she bounced back -- although the first three days after her surgeries were both very painful.
Cost is another factor. Malone financed the $14,000 cost of her mommy makeover with a gift from her father. Brock paid for both of her surgeries with a credit card.
In 2006, Americans spent $11.5 billion on cosmetic procedures. The national average surgeon's fee for breast augmentation was $3,600. Tummy tucks averaged $5,063 and liposuction, $2,750. Add anesthesia, hospital fees, and other incidentals, and the price tags rise significantly.
Casas charges $7,000 to $8,000 for a breast augmentation using saline implants. Silicone adds another $1,000. She bills $9,000 to $10,000 for a tummy tuck, and $3,000 per area for liposuction. Mackenzie's costs are comparable.
A Different Choice
Not everyone is rushing to the operating table, however.
Casas estimates that the breasts of one-third of the mothers she's seen during her 18 years of practice return to normal after pregnancy -- if their weight does. Another third suffer from stretched skin and less breast tissue. The final third, which often includes those who do not lose the baby weight, have larger breasts after their deliveries.
She also recommends that patients try and tighten up their abdominal area first through diet and exercise, which in many cases allow them to bypass a tummy tuck.
"Some women bounce back like nothing ever happened," Mackenzie says. "Some women's bodies are ravaged after pregnancy."
For other mothers, it's an issue of priorities -- and a woman's well-being.
Malone's younger sister, Joanna Duke, a 28-year-old public relations representative and mother of two in Decatur, Ga., is opposed to mommy makeovers. She believes that many women are trying to solve emotionalproblems with the surgeries.
"It's like putting a Band-Aid on a larger issue that you're not willing to work on," she says. "You need to fix those issues first. Then, if you still have a self-esteem problem -- or whatever is driving you to have elective surgery -- get it done. But go to counseling first, because nine times out of ten, the people that I know also have emotional issues going on."
Kathryn Probasco, 38, of Sacramento, Calif., shares that view. Currently pregnant with her third child, the attorney and physician's wife admits that while she occasionally misses her pre-pregnancy body, she won't ever undergo postpartum plastic surgery.
"Looking old doesn't concern me -- not especially," she says. "Part of self-acceptance is accepting the changes that occur in life when you become a parent, and I mean mentally, physically, emotionally, and spiritually. If your biggest concern after you give birth is whether your boobs sag, then your priorities are in the wrong place."
Casas is also concerned about her patients' overall health. She prefers the term "restoration" to "mommy makeovers," and unlike many plastic surgeons, refuses to operate on anyone who isn't willing to practice self-discipline.
"Liposuction, yes, but I won't perform invasive plastic surgery on someone who is 30 pounds overweight," she says. "I require all my patients to exercise and have good nutrition. If you want me to artificially suture your [abdominal] muscles, that's fine. But you can blow it out again by overeating or overdoing it. So why not just work on it before the surgery?"
Casas offers these recommendations to women considering mommy makeovers, so that they'll attain the best possible outcome -- and maintain those results. She suggests that postpartumplastic surgery patients:
- Achieve their desired target weight first.
- Make sure they are exercising at least 30 minutes per day: a minimum of 15 minutes of interval training and 15 minutes of resistance training, alternating different body parts, on different days of the week.
- Practice superb nutrition.
- Keep alcohol consumption at less than 2-3 drinks per week.
- Quit smoking.
- Establish a no-fail support system for the full recovery period dictated by your surgeon.
This last requirement, she says, is critical.
"The biggest problem with mommies is that they don't have someone to take care of their babies and their kids, and they don't take care of themselves," Casas explains. "I won't operate on a mother with kids under 5 unless she has someone to take care of her children for at least two weeks. It just doesn't make sense if you're going to be lifting and driving and doing the laundry and cleaning house. You're just going to ruin your results."
So far, neither Brock nor Malone is complaining about their results -- or doing anything to jeopardize them.
"Oh, my gosh!" Brock says. "My self-esteem is amazing! I can look in the mirror again without cringing."
Malone says the experience has given her a renewed sense of self.
"I just love being a girl and a woman again," she gushes. "I'm feeling more and more like an individual. My old personality is creeping back."
Casas reminds those who have had mommy makeovers that nothing is permanent. In addition to the inevitable aging process, some procedures need ongoing surgeries.
"Breast implants, like all medical devices, require maintenance," she says.
Which is precisely why women like Probasco insist it's far better to forgo postpartum plastic surgery entirely than begin the never-ending fight against time.
"Everybody ages," she says. "Hopefully, at some point, our society will honor those changes instead of stigmatizing them."