Breast Augmentation and Tummy Tuck

1. What Is Mommy Makeover?

Mommy makeover is a combined aesthetic surgery plan that addresses shape changes in the breast and abdominal area after pregnancy and breastfeeding in a single session.

In the combination described on this page:

• Breast volume is increased with implants and or fat injection,
• Sagging, stretch marked skin and muscle separation in the abdominal area are corrected

within the same operation.

The aim is to bring the body form after the motherhood period to a shape that is as balanced, natural and harmonious with the body structure as possible.

2. In Which Situations Is the Breast Augmentation and Tummy Tuck Combination Preferred?

This combination is generally preferred when:

• There is loss of volume, emptiness or sagging in the breasts after pregnancy and breastfeeding,
• The patient wants the breasts to look fuller, perkier and more symmetrical in clothing,
• There is looseness, stretch marks, forward bulging and excess skin in the abdominal area,
• The patient wishes to correct both breast and abdominal area under a single anaesthesia and experience only one recovery period,
• The changes in the breast and abdomen are negatively affecting daily life and self confidence.

In some patients these surgeries may be planned in separate sessions. The decision for a combined operation is made by the surgeon based on the patient’s general health, body structure and safe operation time.

3. Who Is a Suitable Candidate for Mommy Makeover?

In general, suitable candidates are those who:

• Are in a general state of health that is appropriate for surgery,
• Have preferably completed the pregnancy and breastfeeding period,
• Have relatively stable weight and do not plan major weight changes in a short time,
• Can clearly express their expectations regarding breast size, shape and the abdominal area,
• Have realistic expectations about scars, healing time, implant follow up and compression garment bra use,
• Are able to comply with the recommended restrictions in the postoperative period.

In patients who plan another pregnancy in the near future, the timing of surgery should be carefully evaluated together with the surgeon. A new pregnancy can cause further changes both in the abdominal wall and the breasts.

4. Preoperative Evaluation and Planning Process

Before surgery:

• The patient’s medical history, chronic diseases, regular medications and allergies are evaluated.
• A breast examination is performed and, depending on age, family history and risk profile, breast ultrasound and or mammography may be requested.
• The current volume of the breasts, degree of sagging, rib cage structure and skin quality are assessed.
• Possible implant sizes, shape (anatomical or round), placement plan (under the muscle, dual plane etc) and incision site (inframammary fold, around the areola etc) are discussed in detail with the patient.
• In the abdominal area, muscle separation (diastasis), excess skin, stretch marks and fat distribution are evaluated.
• Necessary blood tests, anaesthesia assessment and additional investigations are completed.
• Recommendations are provided regarding discontinuation or reduction of blood thinning medications, certain supplements and smoking before surgery.

At this stage, the amount of change that can be achieved in each area with surgery is explained clearly, realistically and in an understandable way.

5. How Is Breast Augmentation Performed in a Mommy Makeover? (Implant and or Fat Injection)

Breast augmentation is most often planned with:

• Silicone breast implants,
• In some patients a combination of implant and fat injection.

Breast augmentation with implants

• The selected implant is chosen according to the patient’s rib cage structure, skin thickness and expectations.
• The implant is usually placed through incisions:
  1. In the inframammary fold, or
  2. Around the areola in some cases.

The position of the implant may be:

• Under the breast gland (subglandular),
• Under the chest muscle (submuscular), or
• In a dual plane position between the muscle and the breast gland.

The goal is for the breasts to have a volume that is natural, balanced and in harmony with body proportions.

Support with fat injection

In suitable patients, fat removed by liposuction can be processed and injected around the breast to soften contours and transitions.

This approach can be preferred especially to provide a softer transition and natural fullness in the upper pole.

Note on breastfeeding

In breast augmentation performed after pregnancy and breastfeeding, most techniques aim to preserve milk ducts and glands as much as possible. However future breastfeeding capacity cannot be predicted with certainty for every patient. This topic should be discussed in detail before surgery.

6. How Is Tummy Tuck Performed in a Mommy Makeover?

In a tummy tuck (abdominoplasty) the aim is to:

• Remove excess skin and fat tissue in the area below the navel,
• Repair separation between the abdominal muscles when needed (diastasis) to strengthen the abdominal wall,
• Give the abdominal area a flatter and more tightened appearance.

In general:

• A horizontal incision is planned that runs along the bikini or hip line and can be hidden under underwear.
• The navel is freed and the abdominal skin is pulled downward from the upper abdomen, removing the excess.
• The navel is repositioned at an anatomically appropriate point on the newly tightened abdominal skin.
• Incisions are closed with aesthetic suturing techniques and drains are placed if necessary.

If the problem is more limited, smaller procedures such as mini tummy tuck may be considered in some cases. This decision is made during examination after evaluating the condition of the abdominal wall.

7. The First Postoperative Days: Pain, Drains and Hospital Stay

After surgery:

• In the first hours the patient is monitored closely in the recovery unit and in the room.
• Drains may be placed in the breast and abdominal areas to help remove fluid that accumulates in the early period.

In the first days:

• A feeling of fullness and pressure in the chest,
• Tightness in the abdomen and the need to walk slightly bent forward,
• General fatigue and mild to moderate pain

are normal.

Painkillers and other medications recommended by the surgeon are used regularly to make the process as comfortable as possible.

In most patients, one night in hospital is recommended after combined breast augmentation and tummy tuck; in some situations this may be extended to two nights.

8. Staying in Istanbul, Follow Ups and Returning Home

For patients coming from abroad or from another city:

• It is usually recommended to stay in Istanbul for 7–10 days so that the first dressings, removal of drains if used, adjustment of compression garment and bra and incision checks can be completed.

During this period the following are explained in detail:

• How to lie down and get up,
• How much walking is allowed,
• How to shower and care for the wounds,
• How to use medications and which warning signs to watch for (sudden swelling, severe pain, fever etc).

Before long flights, the risk of clots and the effect of long seated periods should be considered. Flight timing should always be planned together with the surgeon. If necessary, advice is given about breaks during the flight, fluid intake and leg exercises.

9. Returning to Social Life, Work and Sports

At home

• In the first days it is important to have support, especially for patients with small children. Lifting children, frequent bending and heavy housework should be limited for some time.
• After tummy tuck walking with a slight forward bend for the first week is normal and a more upright posture is gradually achieved in the following days.

Return to work

• For desk based jobs a return to work is usually possible after about 10–14 days.
• For physically demanding jobs a period of about 3–4 weeks is planned depending on the nature of the work.

Return to sports

• Light walking is encouraged from the early days, at a level considered appropriate by the surgeon.
• For exercises that strain the chest and abdominal muscles, weight training and high intensity sports it is usually necessary to wait 6–8 weeks.

Final approval and adjustment of activity level are determined individually at follow up visits.

10. Scars, Compression Garment and Bra Use, Breastfeeding and Implant Follow Up

Scars

• In breast augmentation there is usually a short scar in the inframammary fold, and in some techniques around the areola.
• In tummy tuck there is a horizontal scar along the bikini line and a shorter scar around the navel.
• The colour of the scars fades and matures over time. They do not disappear completely, but often become less noticeable over 6–12 months.

Compression garment and bra

• An abdominal compression garment supports the abdominal wall, helps to reduce swelling and maintains shape and is generally recommended for 4–6 weeks.
• A supportive or sports bra helps maintain implant position and supports the new breast shape and is again usually recommended for regular use over about 4–6 weeks.

Breastfeeding

• When breast augmentation is performed after pregnancy and breastfeeding, most techniques aim to respect milk glands and ducts.
• However future breastfeeding capacity differs from patient to patient and cannot be predicted in advance with certainty. This topic should always be discussed in detail before surgery.

Implant follow up

• Living with breast implants is a long term process and requires regular control.
• As the body changes over time or with factors such as pregnancy and weight fluctuations, the shape of the breasts may change.
• The frequency of follow up and imaging methods if needed (ultrasound, MRI etc) are planned by the surgeon according to the patient’s situation.

11. Possible Risks and Complications

As with any surgical procedure, combined breast augmentation and tummy tuck carries certain risks:

• Bleeding, infection
• Delayed wound healing, wound breakdown
• Asymmetry in the breasts, implant position different than expected
• Capsular contracture around the implant and rarely other implant related problems
• Contour irregularities in the abdomen, fluid collection (seroma)
• Temporary or longer lasting changes in sensation (nipple, abdominal skin)
• General surgical risks such as blood clots (deep vein thrombosis)

To reduce these risks, appropriate patient selection, a well planned operation, an experienced surgeon and adherence to postoperative instructions are very important. All possible situations are explained in detail to the patient before surgery.

12. Results and Expectation Management

In the breast augmentation and tummy tuck combination, the goals are to:

• Bring breast volume and shape to an aesthetic size that is in harmony with the body,
• Give the abdominal area a flatter, tighter and more toned appearance,
• Help reduce the physical and emotional effects of post pregnancy body changes.

In the first weeks results may not be fully visible due to swelling, bruising and a feeling of tightness.

• The general shape becomes clearer within 6–8 weeks.
• Scar maturation and adaptation of body image to the new form take place over several months.

The most satisfying results are obtained in patients who have realistic expectations, maintain stable weight, attend follow up visits and consistently follow the surgeon’s recommendations.