Mommy Makeover Video NYC Patient #1

Mommy Makeover Video:

Patient 1

Video Transcript:

This is Dr. Carlin Vickery. I am a board-certified plastic surgeon with thirty years’ experience practicing in New York, New York.

The following video will cover a candidate who has undergone a Mommy Makeover surgery. Photographs will include some nude shots of surgical sites. Reviewing this video will give you an in-depth understanding of the surgical procedure and ideal surgical results.

This is a 39-year-old female who underwent a twin pregnancy in 2007. Since delivering, the patient, despite exercise and diet, has had persistent abdominal laxity and a lack of integrity of her abdominal wall. She presents for improvement in her abdominal wall contour and in addition is concerned that she has a developing hernia. Additionally, the patient is complaining that she has bilateral laxity of her breasts as well as loss of the volume of her breasts after her delivery and nursing. The patient would like to have improvement in her breasts as well as in her abdomen.

On this first slide one sees a patient who is of a good weight. She is approximately 5 feet 4 inches tall. You can see that her abdominal wall has a lack of contour and there is protrusion of the abdominal wall extending from her bra line to below her panty line.

As you move to this next slide you can see the protrusion again extending and you can see the increase in the size of her umbilicus. Next slide in which she is directly facing you, one can see that the mid portion of her abdomen extending from the mid line of her breasts shows complete diffuse protrusion of her abdomen and a loss of contour. Continuing circumferentially through the photograph she has additional protrusion on the oblique shot and in the slide, again full lateral, similar symmetrical protrusion of her abdominal wall. The protrusion represents a separation of the abdominal wall musculature. The separation of her abdominal wall muscles means that she no longer can engage her core musculature even with exercise. If the separation between the muscles is wide, the muscles will not be able to activate in a functional manner.

In the next slide there is a diagram of the abdominal wall musculature. Most people are familiar with the washboard muscles which are the mid-line muscles that run from the breasts to the pubic area. Between those muscles there is a layer called the fascia which is the dense connective tissue of the abdomen. During any pregnancy where there is undue pressure on the abdominal wall that fascia stretches like a piece of taffy.

It is possible through exercise to increase the integrity of the muscles, however, if the fascia is taffy-like, no amount of exercise will improve the abdominal wall contour. Surgery is required in this instance to re-approximate the washboard muscles to the mid-line through a series of incisions which will take place from the base of the breasts to the pubic area. Additionally, if patient has excess skin, this can be removed at the time of the repair of the abdominal wall. Replacing the muscles to the mid-line will allow the core muscles to function as they are designed which will not only improve the abdominal wall contour but also improve the support of the back and reduce any future back pain.

Moving to the slide of the breasts, the patient is first shown in an oblique position. It demonstrates that there is a loss of volume in the upper pull of the breasts and that the majority of the breast tissue is below what is designated as the inframammary fold which is the lowest portion of the breast on the abdomen.

In the next slide, one is looking at the front section. The patient has the classic droopy breasts with minimal volume on the upper chest wall and the majority of the volume of the breasts sitting over the abdomen. These patients require a breast lift and if they desire significant volume in the upper chest wall they will also require a breast implant in order to achieve the desired result.

Advancing to the next slide, again there is an oblique view demonstrating the droopiness of the breasts or in medical terms the ptosis of the breasts on the abdominal wall. And finally advancing, one sees the volume of the breasts below the inframammary fold.

The next photograph is a close up of the abdominal wall again demonstrating the protrusion of the abdomen. In fact one would almost think that this patient is still pregnant and many of the patients who seek abdominoplasty surgery do feel that they are mistakenly identified as being pregnant even after they have delivered.

Advancing to the next slide is again more close ups in an oblique view demonstrating the protrusion of the abdomen. One can easily see that the washboard muscles previously described have been stretched out and are not functioning adequately.

The first postoperative shot demonstrates the dramatic change in the profile of the abdominal wall contour. The patient now has a flat or in medical terms scaphoid abdomen and the washboard muscles are in fact contracting and allowing the core muscles across the entire back and abdominal wall to function properly.

Moving to the front view, one can see again that the bulging throughout the washboard muscle area is now corrected and the patient has resumed her pre-pregnancy abdominal wall contour. Again an oblique side view demonstrates the improvement and moving to the breast area, one can see that the breasts now have increased superior pull volume, the nipple areolar complex is now facing outward and no longer facing inferiorly and there was an increase in breast volume above the inframammary fold.

The scars seen postoperatively are in an early healing phase. The scar from the breast lift is around the areola and there is a straight line scar, vertical scar that goes down to the inframammary fold. This is necessary if there is excess skin and ideally over time this will fade and be acceptable to the patient.
The frontal view demonstrates an increase in the projection in the superior pull of the breast. If the patient had desired more projection she would necessitate a breast implant in order to achieve high projection on the upper chest wall.

The next view is a side view of the abdominoplasty again demonstrating a completely flat abdomen. The scars from the abdominoplasty are completely covered in the bikini line and there is excellent tapering of the abdominal wall correction into the love handle area with no additional bulging.

One can see in the next view the end of the scar which is covered in the bikini line. And the frontal view again demonstrates that the scar is completely hidden in the bikini line. The umbilicus is a new umbilicus. There is a small scar around it which is largely imperceptible.

In the medical photograph without the bikini one can faintly see the scar which was necessary in order to remove the excess skin and this is on both sides of the lower abdomen and tapers nicely into the love handle area. Patients must be comfortable with the notion that they are going to have a scar and that the improvement in their abdominal wall contour is balanced by the necessary scar along the lower abdomen. Again, a frontal view demonstrating the scar well hidden within the bikini line. The next slide demonstrates the patient in her bikini with her breast. There is excellent cleavage and the scars are well hidden.

Finally, a juxtaposed preoperative and postoperative photograph demonstrating the dramatic increase in profile of the abdominal wall contour and the functional correction of the muscles. It is worth repeating that this could not be achieved without the surgical correction of the mid-line of the abdomen due to the large amount of stretching of the fascia which is the major tough support structure of the abdomen.

The next slide demonstrates the frontal juxtaposed view again demonstrating the correction up from the xiphoid which is the top of the abdomen down to the pubic area and again with the improvement of the washboard muscles allowing the patient’s excellent preoperative figure to be shown. Juxtaposition in the next slide of the breasts preoperatively and postoperatively, again appreciating the better support of the lower aspect of the breasts and the improved contour of the tissue which is full and middle-aged looking on the side views to the center of the breasts allowing for a more youthful appearing breast. The next slide is the pre and postoperative views again demonstrating the change between the middle-aged looking saggy breast on the left side to a more youthful appearing breast on the right side.

This is the end of the video presentation. I hope it has furthered your understanding of the Mommy Makeover surgery.