May 2014 Plastic Surgery Practice
Andrew N. Kornstein, MD, on the evolution of the modern mommy makeover
By William Payton
Mommy makeovers remain one of the more popular combination treatments in cosmetic surgery. In 2013, the three procedures most often included in a mommy makeover package—breast augmentation, liposuction, and tummy tuck—ranked first, third, and sixth, respectively, in popularity among women, according to the American Society of Plastic Surgeons.
Plastic Surgery Practice sat down with Andrew N. Kornstein, MD, a New York City-based plastic surgeon, to discuss the surgical innovations that have helped mommy makeovers become more popular among mothers looking to get their pre-pregnancy, breast-feeding, and child-rearing bodies back.
PSP: Are mommy makeovers a big part of your practice?
I have always performed a great deal of breast surgeries, including revisions, reconstructions, and fat grafting-based augmentations. The women who request these procedures are often in the same population as those who desire mommy makeovers. So yes, mommy makeovers make up a significant part of my practice.
PSP: Have you seen an uptick in these procedures?
I’ve been doing these procedures for a long time, and it has actually been pretty steady over the years. But what used to be a combination of tummy tuck, liposuction, and breast augmentation is now called a mommy makeover. So, in my opinion, it’s just that there is more awareness than there used to be because people are using the term “mommy makeover” for this triad of procedures. Though it has always been popular, the mommy makeover is certainly more complex than it used to be, thanks to the advent of new, noninvasive modalities, implant types, and the use and variety of acellular dermal matrix. This complexity has enabled us to achieve a better and longer-lasting aesthetic result.
It depends on the patient. Some surgeons do what they like to do or what they’re comfortable with, but I try to engineer the cure for each individual circumstance and the patient’s desires. For me, it’s very important to have the ability to provide what’s best for the individual patient, which is why I offer a full spectrum of both invasive and noninvasive modalities. This is important not just for plastic surgeons but in all specialties. For example, if a cardiologist is more comfortable with medication but the patient needs surgery, the doctor has to be careful not to lean on what he’s comfortable with. Otherwise, a lot of patients won’t get the care they need.
Some patients do well with surgery, other patients do better with nonsurgical treatments, and still others benefit from a combination of both. That having been said, noninvasive body-contouring modalities play a big role. Unlike surgical modalities, which generally provide quantitative changes, noninvasive modalities are capable of providing a qualitative change. But there are a lot of companies on the market offering a lot of different technologies, and they’re all in it to make money, so surgeons have to be critical consumers to know which ones work and which ones don’t. Once a surgeon purchases a machine, there is the potential for conflict of interest, so we have to make sure what we purchase is very efficacious—as reliable as our own two hands.
PSP: Do the new form-stable breast implants have a role in mommy makeovers?
Yes. Women who have done a lot of breast-feeding typically experience a loss of volume in the breasts. The skin is really just a covering device, and it’s not even a great covering device. If you place an implant under skin with very thin breast tissue coverage, you’re going to see a lot of implant edges. So form-stable cohesive gels (aka, gummy bear implants) offer two advantages over conventional gel implants: they minimize the amount of rippling (because they’re firmer), and they give a skin shape.
However, the patient still needs to identify her desired aesthetic. If a patient chooses a more low-profile or subtle augmentation, gummy bears usually aren’t the right choice, because they offer the wrong aesthetic. In these cases, we typically use other modalities to make up for the thinness of the tissue—namely, Strattice®, Seri® Surgical Scaffold, or autologous fat-grafting injections around the implants.
There is no set amount of time that a woman needs to be at a stable weight. I don’t want my patients to focus on an artificially lower weight or some arbitrary target weight. I like to work on a patient once she is at a weight she is most likely to maintain—that’s the most important thing. Usually, the patient knows when she has stabilized and is at the right weight. This typically occurs after she is done breast-feeding—usually around 3 to 6 months after surgery—but in some cases, it takes a couple years. A patient who has lost an extraordinary amount of weight (eg, 100 pounds) should wait longer, because she is likely to regain some of the weight.
PSP: Risks increase with multiple surgeries. How are these mitigated today?
The potential risks are mitigated by tailoring the procedure to the patient. If a patient is in good physical shape, it is not uncommon to perform the entire procedure in 1 day. However, in cases where I am doing a significant reduction (eg, a case involving significant liposuction with body lifting), it’s a good idea to focus on the body first, then wait 3 to 6 months before doing the breast, because the optimal breast surgery will be in better focus for the patient to see.
I am doing studies on a device called Seri Surgical Scaffold, which is a silk implant that turns into one’s own collagen. This will be an important contribution for patients who have a great deal of laxity from multiple pregnancies. For these patients, the body’s deep fascia layer, which I like to think of as a layer of plastic wrap, has undergone a lot of trauma and stress, and ends up having a consistency like stretched taffy. In other words, it’s not very stable, and trying to repair it is not very effective. By using Seri Surgical Scaffold at the union of the fascia’s edges, repairs will be enhanced with the body’s own collagen, so they will be more stable. Thus far, our studies have shown that Seri Surgical Scaffold is very helpful to enhance wound strength, and patients feel the result is more stable.
William Payton is a contributing writer for Plastic Surgery Practice magazine. He can be reached via [email protected].
Original citation for this article: Payton, W. Mommy makeovers: The new generation. Plastic Surgery Practice. 2014 May; 24-25.