Baby, I love you, but what did you do to my body?

Congratulations! You’re going to have a baby!

And with those magical words, an entire universe opens up before you. Strangers that have no problem offering their opinions on breastfeeding, mommy-and-me groups that give you the scoop on whether tiger-mothering or helicopter-parenting is more on trend today, and apps that let you know precisely which fruit your growing fetus resembles this week.

Yet with all the information and advice available to new-mothers-to-be, surprisingly little is said about what happens to your body afterwards. If we have only celebrities and friends on Facebook as evidence, apparently not only does your brand new baby get a cute little beanie upon arrival, as a brand new mom you will be magically gifted a sparkling six-pack! (thanks, Stacy Keibler)

Photo Source: <http://people.com/babies/celebrity-moms-before-and-after-pregnancy/stacy-keibler>

This complicates the already challenging maelstrom of emotions a woman experiences immediately postpartum, as she wonders why her body still looks a little (or a lot) pregnant. But here’s the dirty little secret: this is completely normal.

The human body - particularly the female version, in this case - is a remarkable instrument. You are making a completely new human being (maybe even more than one) in there, and it takes about nine months (actually, closer to ten - and that’s another dirty little secret for you). So ladies, please don’t torture yourselves because you’re not bikini-ready a month after having a baby - the process of reclaiming your body takes some time, too.

And this is important too: there is no room here for mom-shaming or girl-on-girl aggression. Our bodies are beautiful and strong and deserve celebration. A few women’s bodies snap back into something remarkably close to their pre-pregnancy state quickly, while others never quite get there. Some moms aren’t bothered by the changes in their breasts; put on a properly-fitted bra, and they’re good to go. Many women bear (and bare) their stretch marks on their bellies with pride. C-section scars become a badge of honor.

But some mothers find that the changes to their bodies affect their self-esteem and sense of self-worth. Certain post-partum changes are resolutely resistant to any amount of thoughtful nutrition, any variety of fitness classes, and any style of shapewear: stretch marks appear overnight and refuse to fade, breasts can deflate and sag after months of nursing and pumping, and bellies can be left with a constant pooch or extra wrinkly skin.

For some of these women, surgery can offer a dramatic and lasting improvement to the areas that concern them, allowing them to be comfortable in their bodies again. And this is okay, too. Although there have been a spate of celebrities swearing off makeup and Botox and plastic surgery, it comes down to this: every woman has to respect what is best and right for herself.

"Mommy Makeover"

For most women, the rewards of motherhood far outweigh the toll that pregnancy, childbirth and breastfeeding takes on our bodies. Despite the joy our little ones bring, having a baby can also change a woman’s body in ways that even diet and exercise can’t completely reverse.

A growing trend among mothers is the “mommy makeover,” a variety of procedures to rejuvenate the post-partum body. From eliminating stretch marks to flattening the tummy and lifting the breasts, these procedures can change not only how a woman looks, but also how she feels about her body after baby.

Stretch Marks
Stretch marks that result from pregnancy, technically known as “striae gravidarium”, occur in up to 90% of pregnant women. Most stretch marks appear on the lower abdomen but can also occur on the breasts, hips and thighs. Stretch marks appear when the deep layer of skin, the dermis, stretches beyond its capacity and creates small scars.

While many products claim to prevent or diminish stretch marks, unless a product penetrates the dermis, it is physically unable to produce a dramatic effect. While topical retinoids like Retin-A can reduce the appearance of stretch marks, they are contraindicated during pregnancy and should not be used during breast-feeding.

The only effective solutions for stretch marks are direct excision or laser treatment. Traditionally, treatment for stretch marks on the lower abdomen has been tummy surgery to remove both the belly skin and stretch marks. Recently, the Fraxel fractionated CO2 laser has been shown to reduce the appearance of stretch marks. It requires several treatments but has little down time.

Loose Belly Skin
Pregnancy not only expands the abdominal skin, but also causes the abdominal muscles, specifically the rectus abdominus (i.e., the “6-pack” muscle), to stretch. These changes are caused not only by the growing uterus pressing against the abdominal wall, but also by the pregnancy hormones that relax connective tissue.

The result for many women after childbirth is extra belly skin and stretched muscles that no amount of abdominal crunches can tighten. First, we always remind mothers to give their bodies time to heal. If, however, a focused exercise routine and sensible eating are insufficient, then abdominoplasty (or tummy tuck surgery) may be a good option.

Depending on each woman’s shape, tummy tuck surgery ranges from a simple procedure where a small amount of excess skin below the navel is removed to an extensive operation where belly skin and fat are excised and the abdominal muscles surgically tightened. Liposuction is often added to address fat deposits of the hips and flanks commonly present after pregnancy.

Abdominoplasty is a dramatic operation with nearly immediate results. However, it is important to understand that abdominoplasty should be performed after childbearing is completed, as any subsequent pregnancy will affect the results of surgery.

Sagging Breasts
While many women have increased breast fullness during pregnancy and nursing, breasts often appear deflated afterward. The combination of tissue atrophy with stretched skin can create a saggy appearance after childbearing.

While a good bra performs wonders in clothes, improving the shape of the breasts themselves often requires a breast lift (or mastopexy). With a breast lift, extra skin is removed and the breast is reshaped to a more youthful position. Sometimes, an implant is added to restore lost volume, particularly in the upper breasts. Women with a mild droop or loss of fullness can often get a nice rejuvenation with implants alone. Like tummy tuck surgery, these procedures have an immediate effect, restoring the appearance of the breasts before their volume loss.

While stretch marks and extra skin may be a small price to pay for the privilege of motherhood, with a little help many women today are enjoying their bodies after baby.

References
1. Ud‐Din S, McGeorge D, Bayat A. Topical management of striae distensae (stretch marks): prevention and therapy of striae rubrae and albae. Journal of the European Academy of Dermatology and Venereology. 2016;30(2):211-222.
2. Yang YJ, Lee G-Y. Treatment of Striae Distensae with Nonablative Fractional Laser versus Ablative CO2 Fractional Laser: A Randomized Controlled Trial. Annals of Dermatology. 2011;23(4):481-489.

By Jennifer Weintraub, M.D. and Angeline Lim, M.D.
Angeline Lim, M.D. and Jennifer Weintraub, M.D. are the board-certified plastic surgeons of Duet Plastic Surgery, a boutique-style practice in Palo Alto, California. After earning their medical degrees from Northeast Ohio Medical University and Albert Einstein College of Medicine respectively, Dr. Lim and Dr. Weintraub completed their plastic surgical training at the highly selective and renowned residency program at Stanford University Medical Center. Proud to be the brains and brawn behind their small business, Dr. Lim and Dr. Weintraub find it equally challenging and joyful to return to being a mom to each of their young families at the end of every day.