by Michael J. Yoo, M.D.
Pregnancy is a remarkable period in a woman’s life as her body prepares to bring a child into this world. But the physical changes, like weight gain and stretch marks, that occur during pregnancy and with breastfeeding can linger and be a cause for persistent concern to the mother. Why is pregnancy a natural “tissue expander?” And what can be done to treat these problems? From the skin to the breasts, let’s explore some science.
During pregnancy, the growing child requires more and more room within the mother’s womb, or uterus. The uterus expands as the child grows, and in turn expands the belly and the overlying skin. At the same time, the breasts begin to swell in preparation for milk production and breast feeding.
Skin, the largest organ in the human body, is intrinsically elastic and can stretch to a certain limit. Up to this limit, constant stretch, as occurs during pregnancy, creates more skin. Beyond this limit, “stretch marks” occur and represent an irreversible breakage of dermal elements (natural constituents within the skin). The degree to which stretch marks occur varies from person to person, depending on their individual skin quality and genetics.
Of course, like all elastic substances, there is some “recoil” of the stretch of skin after the stretching force (i.e. pregnancy and breast feeding) is gone. The degree to which the skin returns to its pre-pregnancy state also varies. Most often, women after childbirth are left with at least some excess skin in the lower abdomen with or without stretch marks. Moreover, the breasts, which swelled during breast feeding, appear ‘deflated’ and droopy (ptotic) because their internal supporting structures (Cooper’s Ligaments) have also been stretched beyond their limit. These changes can be exacerbated by multiple pregnancies and childbirths.
The ‘extra’ skin, stretch marks and overall ‘deflated’ appearance of the abdomen and breasts cannot be eliminated by exercise. In fact, there is no amount of exercise that can correct this appearance. Remember, exercise and weight loss decrease fat content, they have no direct effect on the quantity of excess skin. To the contrary, losing weight (i.e., fat) serves to ‘deflate’ the skin even more, worsening the appearance of excess skin and the droopiness of the lower belly and breasts.
To eliminate this excess skin and correct its droopy appearance, the skin must be surgically excised and re-tailored to conform naturally to the underlying tissue. An abdominoplasty or ‘tummy tuck’ involves excising the excess skin and fat of the lower abdomen. It also involves bringing together the rectus fascia (the tissue covering over the rectus or ‘6-pack’ of abdominal muscles).
Remember, everything about the belly stretches during pregnancy, and this includes the muscle and its coverings. The stretched rectus fascia, which is brought back together by sutures, acts as a ‘natural corset’ and narrows the waistline. Finally, selective liposuction of the flanks and hips can further enhance the result in the right candidate. The overall result is a flatter, more attractive tummy with a fine line scar that can be hidden within the bikini line. The surgery is itself outpatient, and all patients are able to walk the same day.
A breast lift (Mastopexy) is the procedure used to reshape the ‘droopy’ and sagging appearance of the breasts following pregnancy and breast feeding. Excess skin is removed, and the remaining skin envelope is tailored to drape aesthetically to the underlying breast tissue. The nipple, which often appears to be hanging on the lower pole of the breast, is ‘lifted’ to a more natural and aesthetically pleasing position. A breast lift does not actually make the breast larger, but sometimes the reshaping does provide an illusion of greater size. In order to add more volume, some patients choose a simultaneous augmentation with a silicone or saline implant that can make the breasts appear even fuller and larger. A breast lift with or without augmentation is an outpatient procedure, and patients are again asked to walk on the same day as surgery.
There are a variety of modifications to the procedures described above which can be selected according to the individual patient’s physical characteristics and goals. Please feel free to comment on this post with any questions, or contact my office to schedule a consultation. Thanks for reading.