A beautiful new mom came into my office. She’d just had her second child four months ago and was tired of her bulging abdomen. She wanted me to do something about it. She had seen all these celebrity moms on TV and in magazines that seemed to get back to their pre-baby shape instantaneously. She also stated that she heard of plastic surgeons performing tummy tucks immediately after a C-section. She had gotten down to her pre-baby weight and she was “fed up” with the state of her abdomen. On exam, she was at a reasonable weight for her height – lean build, but with a rounded shape to her abdomen, some stretch marks, and skin that was moderately loose. She was okay with the state of her breasts for the meanwhile, as she was breastfeeding.
With pregnancy a number of external and internal changes occur to the body. My obstetrical colleagues take care of the internal ones, and me and my plastic surgery colleagues the external issues. Some women come out of pregnancy looking as good as they did before, if not better. I have a sister-in-law who weighed 15 pounds less than her pre-pregnancy weight after she had my first nephew. No, she did not have hyperemesis gravidarum. Even after two kids, she looks like she hasn’t had any children. She did two main things to help her cause, though, throughout her pregnancy.
One, she didn’t overeat. In fact she consumed the same, normal amount of daily calories that she did before pregnancy. Gisele Bündchen once remarked, “I think a lot of people get pregnant and decide they can turn into garbage disposals.” My sister-in-law was mindful of what she consumed. My nephews are healthy and well on their way to achieving their predicted height of over 6 feet.
Two, she continued exercising throughout her pregnancy. She ran five miles a day during her first pregnancy up to the last month and then walked the last month. She also worked out during her second pregnancy AND held a job outside the home as well. All this she did with her obstetrician’s blessing. She could do this because she was exercising BEFORE she even got pregnant, thus she was not introducing a new stressor to her body. The message here - she didn’t go overboard with the weight gain, and hence her body didn’t take the big hit that comes along with being stretched out beyond the body’s ability to repair itself. Also, maintaining an exercise program even before you get pregnant is helpful.
Now, if you are reading this AFTER your body has taken that hit, don’t despair. If you’ve done your due diligence by eating healthy foods and performing daily exercise but are still struggling, there are avenues you can take, but they will likely involve surgery. If you decide to go the surgical route, most of my colleagues and I would agree that you should wait a minimum of SIX months before having any body enhancing procedures. Some believe that waiting a year is more appropriate.
I have found that there are four main areas that women focus on after having a baby. (Who am I kidding; many of us focus on them even if we haven’t had a baby). These areas are the:
- Love handles/Muffin Top/Flanks
- Vagina and Labia
There are several important considerations as to why waiting is the best plan before considering breast enhancement after pregnancy. Your breasts will be changing for several months after delivery. If you’ve decided to breastfeed, the changes will continue until you've stopped breastfeeding. Breast surgery is not advised until the skin and breast tissue have stabilized. This would be about three to six months after breastfeeding or three to six months after delivery if you are not breastfeeding.
Even at six months post-partum, there may be changes that are occurring to your abdominal wall and the skin and fat of your abdomen. Undergoing liposuction or a tummy tuck at this time may still be premature. Depending on when you began to show, your skin has been stretched out for anywhere from three to eight months. It will need at least that long to recover. It can take up to a year for the abdomen to reverse the effects of pregnancy, and even longer for multiples or for pregnancies that are within a year of each other.
Fluctuating hormones, even without pregnancy, can affect fat loss and fat gain. Just think about how your body changes when you’re on your period. Imagine how much more dramatic these fluctuations are with pregnancy and in the postpartum period. Add to that the hormone shifts involved with breastfeeding! It can take up to one year for hormones to normalize after pregnancy. Liposuction can be done before one year is up, but give yourself some time to work the excess off, especially if love handles are a new phenomenon for you. The best solution is to avoid excessive weight gain during pregnancy in the first place to avoid surgery altogether.
Labia and Vagina
Elongated labia and widening of the vaginal canal are some of the possible consequences of childbearing. If this has happened to you, know that as with the stomach and breasts, some time needs to pass for these areas to adjust after delivering a baby. If you feel as if your vagina is looser than it was before having a vaginal delivery and it is affecting your sex life, a vaginoplasty is a possibility, but should be done at minimum six months after delivery. If you’re considering having more children, it may be prudent to wait until all childbearing is done. Then again, one may argue that if the vagina is too loose, there will be no more childbearing because sex is “just not the same” and thus is not happening!
As for the labia or vaginal lips, these will shrink after delivery. Elongated vaginal lips are not always a consequence of pregnancy, as some women have them after puberty. If you find that they get in the way of intercourse, exercise, or inhibit your clothing styles, a labiaplasty may be the surgery for you. Just remember, the body needs time to adjust – at least six months- before considering this procedure after pregnancy.
In my opinion, and this is just