What is a Mounjaro makeover?
You may see terms such as “Mounjaro makeover”, “Ozempic makeover” or “GLP-1 makeover” appearing online.
They are marketing terms rather than specific operations.
A patient who has lost substantial weight may need only an abdominoplasty.
Another may primarily be bothered by changes to the breasts.
Someone with more extensive skin laxity may benefit from several procedures carried out in stages.
I therefore prefer to think in terms of post-weight-loss breast and body-contouring surgery, rather than offering a standard package.
The surgery should fit the patient — not the name of the medication they have taken.
During your consultation we will discuss what matters most to you, what your options are, the risks, recovery and likely cost of treatment as part of an individualised and thoughtful approach.
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Breast implants: Over or under the muscle?
One of the most common questions women ask when considering breast augmentation is whether their implants should sit over or under the chest muscle.
There is no single position that is best for everyone. The right choice depends on your existing breast tissue, skin thickness, chest shape, implant size and the result you would like to achieve.
What does “over the muscle” mean?
With an over-the-muscle augmentation, the implant sits in front of the pectoralis major muscle and behind your breast tissue.
Potential advantages include less disruption of the chest muscle, often a relatively comfortable recovery and no movement of the implant when the pectoral muscle contracts (Animation).
However, women with very little natural breast tissue may have less tissue covering the implant, potentially making the implant edges or rippling more visible.
What does “under the muscle” mean?
The term is slightly misleading because modern breast augmentation commonly uses a dual-plane technique rather than placing the whole implant beneath the muscle.
The upper part of the implant is covered by the pectoralis muscle while the lower part sits beneath the breast tissue.
This provides additional tissue coverage over the upper implant and can be particularly useful in slim patients or women with relatively little natural breast tissue.
The trade-off is that surgery involves the chest muscle and there can be more early discomfort. As the muscle is sitting on top of the implant, movement of the muscle will move the implant - this is known as animation. Some patients find this more troubling than others.
Does under the muscle look more natural?
Not automatically.
A natural-looking result depends on the whole surgical plan — including implant dimensions, volume, profile, breast tissue, skin quality and implant position.
For a woman with sufficient breast tissue, an over-the-muscle implant may look very natural.
For someone with very thin tissue coverage, dual-plane placement may provide a smoother transition across the upper breast.
In some cases - fat transfer to the breast can be used to mask the upper part of the implant instead of placing it below the muscle.
Is one position safer?
Both techniques are well-established.
Rather than routinely using one implant plane for every patient, I prefer to select the position according to the individual breast.
Factors I consider include:
the amount of natural breast tissue covering the implant
breast and chest-wall dimensions
skin quality
implant size and profile
degree of breast droop
exercise and lifestyle
previous breast surgery
the appearance the patient would like to achieve.
What if I exercise or lift weights?
This can be particularly relevant for women who regularly perform chest-focused weight training.
Because a dual-plane implant is partly influenced by the pectoralis muscle, muscle contraction can cause visible movement of the breast in some patients.
For very active patients with suitable tissue coverage, an over-the-muscle position may therefore be worth considering.
This does not mean that everyone who goes to the gym should automatically have implants above the muscle — it is simply one factor in the decision.
So which is better: over or under?
The real answer depends on your shape and your goals.
The best implant position is the one that provides an appropriate balance between soft-tissue coverage, breast shape, implant visibility, movement and your individual anatomy.
During a breast augmentation consultation, I assess the thickness and distribution of your existing breast tissue and discuss the advantages and disadvantages of each option before recommending an implant and surgical plane.
The aim is not simply to choose “over” or “under”, but to create a breast augmentation plan that is proportionate to your body and appropriate for your tissues.
Breast Uplift With or Without Implants?
A breast uplift does not automatically mean having breast implants.
This is worth emphasising because many women assume an implant is required to achieve an attractive shape after mastopexy.
Whether one is helpful depends on your existing breast volume and the result you would like.
What can an uplift achieve without implants?
A mastopexy reshapes the breast using your existing tissue.
Excess skin is removed, the nipple is repositioned and the breast is remodelled into a more elevated shape.
If you already have enough breast volume, this may be all that is required.
Depending on your breast shape, your own tissues can be used to ‘auto-augment’ the breast, giving a fuller feel without the implants.
For those looking for a little extra but without implants, fat transfer to the breasts can provide another option to increase volume whilst staying implant free. This can be undertaken in the same sitting although for bigger changes in volume you may want to consider repeat episodes of fat transfer. If you’re keen to discuss your ‘implant free’ options - book a consultation to consider what options may be available to you.
What does adding an implant change?
An implant adds volume.
It can be particularly helpful where pregnancy, breastfeeding or weight loss has resulted in a significant loss of breast fullness.
An implant can also increase upper-pole fullness — the volume in the upper part of the breast.
Combining an implant with mastopexy is known as an augmentation mastopexy.
What about an “internal bra”?
In selected patients I may discuss additional internal support using surgical mesh.
This is sometimes marketed as an “internal bra”, although I prefer to be cautious with that phrase because no internal device can totally prevent the natural effects of ageing, gravity and future tissue change.
Mesh may provide useful additional support in certain circumstances, but it is not required in every patient.
How do I decide?
Rather than starting with the operation, I start by asking what you want your breasts to look like.
If the priority is primarily to lift and reshape what you already have, mastopexy alone may be appropriate.
If you also want more volume, an augmentation mastopexy may better address your goals.
Book a consultation to go through your options, the risks, recovery and cost of each of these procedures.
Loose Skin After Mounjaro or Ozempic Weight Loss: What Can Surgery Help With?
Modern weight-loss medications such as Mounjaro and Ozempic have helped some people achieve substantial reductions in body weight.
While this can produce major health and lifestyle benefits, significant weight loss can also reveal another issue:
loose skin.
Skin that has been stretched for many years does not always contract when the underlying fatty tissue reduces.
Where does loose skin tend to develop?
Common areas include the:
abdomen and waist, breasts, upper arms, thighs and lower back.
How much skin remains depends on factors including age, genetics, duration of excess weight and the amount of weight lost.
Can exercise tighten loose skin?
Exercise can improve muscle mass, fitness and overall body composition.
What it cannot do is remove a significant fold of excess skin.
Non-surgical skin-tightening treatments may produce relatively modest changes in selected patients, but extensive laxity following major weight loss generally requires surgery if meaningful removal is desired.
Which operations can help?
Loose abdominal skin may be treated with abdominoplasty.
Where skin excess extends significantly in both horizontal and vertical directions, a Fleur-de-Lis abdominoplasty may provide greater correction.
Patients with substantial excess around the entire waist may be candidates for circumferential abdominoplasty.
Loose upper-arm skin can be treated with an arm lift, while significant inner-thigh laxity may be addressed with thigh-lift surgery.
Breast changes following major weight loss may require mastopexy, augmentation, fat transfer or a combination of techniques.
When should surgery be considered?
I would generally want your weight to have reached a level you are comfortable maintaining.
If weight is still changing rapidly, it is usually better to wait because further weight loss can create additional skin laxity.
For patients requiring several body-contouring procedures, surgery is often best approached in stages rather than trying to correct every area during one very long operation.
The objective is to create a plan that balances contour improvement, scars, recovery and safety.
What is a ‘mum pouch’ and what can actually improve it?
The term “mum pouch” is commonly used to describe a persistent area of lower abdominal fullness or loose skin after pregnancy, particularly below the belly button.
It can develop for several reasons, including stretched skin, localised fat, separation of the abdominal muscles and tethering or indentation around a Caesarean-section scar. For some women, exercise and weight loss improve the overall abdomen but do not completely correct this lower abdominal overhang.
The right treatment depends on what is causing the pouch.
Abdominoplasty
A full abdominoplasty, or tummy tuck, is usually the most appropriate option when there is significant loose abdominal skin, particularly above and below the belly button.
The operation removes excess lower abdominal skin and can also tighten separated abdominal muscles where necessary. Liposuction may be added to improve the contour of the waist or flanks.
The main scar runs low across the abdomen and is usually designed to sit beneath underwear or swimwear.
Mini abdominoplasty
A mini abdominoplasty is a smaller operation designed for patients whose skin excess is mainly confined to the lower abdomen.
It removes a more limited amount of skin below the belly button and usually involves a shorter scar than a full tummy tuck.
However, it is only suitable for selected patients. If there is significant loose skin higher on the abdomen, a mini tummy tuck may not provide enough correction.
C-section scar revision
Sometimes the main issue is not excess skin across the whole abdomen, but a C-section scar that is indented, tethered or associated with a small overhang of skin and fat.
In these cases, C-section scar revision may be enough. The old scar can be removed and the tissues released and repaired to create a smoother lower abdominal contour.
In some patients, scar revision is combined with a mini abdominoplasty or liposuction where there is additional skin or fat to address.
Which option is right for me?
The important question is whether the lower abdominal fullness is being caused mainly by skin, fat, muscle separation, scar tethering — or a combination of these.
That is why the best treatment can only be determined after examining the abdomen and understanding what is bothering you most.
For some women, a small scar revision is sufficient. Others benefit from a mini abdominoplasty, while more extensive post-pregnancy changes are better treated with a full tummy tuck.
During the consultation Mr Herieka will discuss your options, the risks and benefits, expected recovery and overall costs.
What is a ‘mummy makeover’?
The term “mummy makeover” is widely used to describe combined cosmetic surgery addressing breast and abdominal changes following pregnancy.
It is not a single standard operation.
A mummy makeover might combine an abdominoplasty with:
breast augmentation
breast uplift
augmentation mastopexy
breast reduction
fat transfer
and may also incorporate liposuction where appropriate.
The operation should always be tailored to the individual patient rather than approached as a fixed package.
Is it better to combine breast and abdominal surgery?
For appropriately selected patients, combining procedures can have advantages.
It may mean:
one general anaesthetic
one period away from work
one main recovery period
simultaneous correction of breast and abdominal changes.
However, combining operations also means longer surgery and a greater physiological burden.
Safety therefore comes before convenience.
Factors including your health, weight, medical history, planned procedures and expected operating time all need to be considered.
Sometimes the safest approach is to combine procedures; in other patients it is better to perform surgery in stages.
When is the right time for surgery after pregnancy?
There is no single date that applies to every patient.
In general, I would want your body to have had sufficient time to recover from pregnancy and for:
breastfeeding to have finished
breast volume to have stabilised
your weight to be reasonably stable
early post-pregnancy abdominal changes to have settled.
It is also worth thinking about whether you are planning further pregnancies.
Having another child after breast or abdominal surgery is possible, but pregnancy can stretch the tissues again and alter the surgical result.
Many women therefore choose to postpone abdominal body-contouring surgery until their family is complete.
Do I need to lose weight before a mummy makeover?
Body-contouring surgery is not a weight-loss treatment.
The most predictable results are generally achieved when you are close to a weight that you are comfortable maintaining.
Significant weight loss after surgery can create further loose skin, while substantial weight gain can alter the result.
The number on the scales is not the only consideration, however. General health, weight distribution, skin quality and the extent of surgery being considered are also important.
What scars will I have?
All operations that remove skin create permanent scars.
For an abdominoplasty, the main scar typically runs across the lower abdomen and is positioned as low as practical.
Breast surgery scars vary according to the operation.
A breast augmentation usually requires a relatively short incision, while mastopexy and breast reduction require additional scars because excess skin must be removed.
For many patients, one of the most important decisions is therefore whether the likely improvement in shape is worth the scar required to achieve it.
That trade-off should be discussed openly during consultation.
What is recovery like after post-pregnancy surgery?
Recovery depends on the operations performed.
After breast surgery alone, many patients return to desk-based work after around one to two weeks.
Following an abdominoplasty, recovery is usually longer, with many patients planning around two to three weeks away from desk-based work.
Walking is encouraged early after surgery.
More strenuous exercise and gym activity are introduced gradually, often over approximately six weeks or longer depending on the procedure.
Combined breast and abdominal surgery naturally requires a greater recovery commitment than a single operation.
You should also consider the practical reality of looking after young children. Lifting restrictions during the early postoperative period often mean arranging additional help at home.
Which operation is right for me?
This is ultimately the most important question.
Two women who have both had two pregnancies may require completely different operations.
One may primarily have abdominal muscle separation and loose skin.
Another may have relatively little abdominal change but significant loss of breast volume.
Another may have changes affecting the breasts, abdomen and flanks.
The purpose of consultation is therefore to identify which anatomical changes are actually responsible for what is bothering you.
From there, we can decide which options are likely to provide meaningful improvement — and equally importantly, which procedures you do not need.
A reconstructive approach to cosmetic breast and body surgery
My NHS practice includes complex breast reconstruction and microsurgery, where understanding blood supply, soft tissues, scars and anatomical proportion is central to achieving good outcomes.
I bring the same principles to cosmetic breast surgery and body contouring.
The objective is not to create a standardised post-pregnancy body.
It is to understand what has changed, what matters to you and what can realistically be improved while maintaining an appropriate balance between result, scar, recovery and surgical risk.
Considering surgery after pregnancy?
There is no expectation that your body should look exactly as it did before pregnancy.
Equally, if physical changes following pregnancy are affecting how you feel about your body, it is reasonable to explore what options are available.
A consultation can help establish whether the changes you are concerned about are best addressed through time, exercise, physiotherapy, breast surgery, body contouring — or a combination of approaches.
Private consultations with Mr Mo Herieka, Consultant Plastic Surgeon, are available at Nuffield Health Wessex Hospital in Hampshire, serving Southampton, Winchester, Bournemouth and the surrounding region.
Body changes after pregnancy: What can surgery help with?
Pregnancy and childbirth can change the body in ways that diet and exercise cannot always reverse.
For some women, the changes are relatively subtle. For others, stretched abdominal skin, separation of the abdominal muscles, loss of breast volume or persistent changes in body contour remain long after pregnancy.
These changes are normal, but that does not mean you have to feel comfortable with them.
As a Consultant Plastic Surgeon specialising in aesthetic breast surgery and body contouring, I regularly meet women who are unsure whether what they are seeing is something that can improve further with time and exercise, or whether surgery would be required to change it.
The answer depends on which tissues have changed.
Why does the body change after pregnancy?
Pregnancy affects more than weight alone.
As the abdomen expands, the skin stretches and the abdominal muscles may separate. The breasts enlarge during pregnancy and breastfeeding before subsequently reducing in volume, sometimes leaving stretched skin or a different breast shape.
Common changes include:
loose or stretched abdominal skin
separation of the abdominal muscles
a persistent lower abdominal bulge
stretch marks
localised fatty deposits around the abdomen and waist
loss of breast volume
breast droop or sagging
enlarged or stretched areolae
breast asymmetry
Exercise can improve muscle tone and general fitness, but it cannot remove significant excess skin or fully reverse some structural changes.
Loose abdominal skin after pregnancy
One of the most common concerns after pregnancy is skin around the lower abdomen that remains loose despite returning to a healthy weight.
Skin has a remarkable ability to stretch, but once it has been stretched significantly it does not always contract completely.
The extent of loose skin varies considerably depending on factors including:
number of pregnancies
multiple pregnancy
genetics
age and skin elasticity
weight gained during pregnancy
weight change afterwards.
When the main problem is significant excess skin, exercise cannot remove it.
For suitable patients, an abdominoplasty — or tummy tuck — may be considered.
What does a tummy tuck do after pregnancy?
An abdominoplasty removes excess lower abdominal skin and reshapes the abdominal contour.
Depending on your anatomy, surgery may also involve:
tightening separated abdominal muscles
repositioning the abdominal skin
creating a new opening around the belly button
combining the operation with liposuction of the abdomen, waist or flanks.
The objective is not simply to create a smaller abdomen, but to restore a smoother, more balanced contour.
Abdominal muscle separation after pregnancy
Pregnancy can cause the two rectus abdominal (six pack) muscles to separate. This is known as rectus diastasis.
Some degree of separation is common during pregnancy and may improve afterwards. Physiotherapy and appropriate core rehabilitation can be very helpful.
However, in some women a significant separation persists.
This can contribute to a rounded or protruding appearance of the abdomen even when body weight is relatively low.
The abdominal muscles can be brought back together as part of the abdominoplasty procedure.
Importantly, not every abdominal bulge after pregnancy is caused by muscle separation, which is why examination is important before deciding whether surgery would be helpful.
Can liposuction treat post-pregnancy abdominal changes?
Sometimes — but it treats a different problem.
Liposuction removes localised fat. It does not remove significant loose skin or repair separated abdominal muscles.
If you have good skin quality and localised fat around the abdomen or flanks you may benefit from liposuction alone.
However, when loose skin is the dominant problem, removing fat without addressing the skin may provide limited improvement and can sometimes make skin laxity look more obvious.
For this reason, liposuction is often used alongside an abdominoplasty rather than instead of one.
What happens to the breasts after pregnancy?
Breast changes following pregnancy and breastfeeding vary enormously.
During pregnancy, the breasts typically increase in volume. When pregnancy and breastfeeding are complete, the glandular tissue may reduce again while the stretched skin remains.
This can result in:
loss of breast volume
loss of fullness in the upper breast
drooping of the breast
downward movement of the nipple
stretched areolae
asymmetry.
Different changes require different operations. A consultation will help you to explore your options and find the best solution for you.
Breast augmentation after pregnancy
If the breast has primarily lost volume but remains in a good position, breast augmentation with implants may restore fullness.
Implants can improve:
breast volume
upper-breast fullness
shape
mild asymmetry.
For some patients, however, adding an implant alone will not adequately address breast droop and an uplift may also be required to achieve the best results.
Breast uplift after pregnancy
When the main problem is loose skin and a lower breast position, a breast uplift — or mastopexy — may be more appropriate.
A mastopexy reshapes the breast, removes excess skin and raises the nipple into a more appropriate position.
Importantly, an uplift can be performed without implants.
Depending on the degree of excess skin - some of this can be repositioned to ‘auto-augment’ the breast - giving a more lifted and fuller appearance without the need for implants. In most auto-augment cases the degree of fullness is less than what could be achieved with implants however this technique can address the goals of those looking for just a little extra.
If you are happy with your existing breast volume but not its shape or position, mastopexy alone may provide the change you are looking for.
If you have very thin or stretchy skin, an absorbable mesh may be recommended to support the breast in its new position and help it to maintain its shape over time. This is sometimes referred to as an ‘internal bra’.
Breast uplift with implants after pregnancy
Many women experience both:
loss of breast volume + breast droop.
In this situation, an augmentation mastopexy combines implants with breast uplift surgery.
The implant restores volume while the uplift reshapes and elevates the breast.
This is a technically more complex operation than either augmentation or mastopexy alone because the surgeon is simultaneously adding volume and tightening the breast envelope.
Careful implant selection and tissue assessment are therefore particularly important.
In selected patients, additional internal support using absorbable surgical mesh — sometimes described as an “internal bra” — may also be considered.
Mesh is not necessary for every patient, and whether it offers a worthwhile benefit depends on factors such as tissue quality, implant choice and the degree of reshaping required.
Breast reduction after pregnancy
Pregnancy does not always result in smaller breasts.
Some women remain with breasts that are substantially larger or heavier than before pregnancy.
A breast reduction removes breast tissue and excess skin while simultaneously reshaping and lifting the breast.
For women troubled by breast weight as well as appearance, reduction surgery can therefore address both breast volume and shape.
Fat transfer to the breasts
For selected patients, fat transfer to the breast offers another option.
Fat is removed using liposuction from another area of the body, processed and then carefully transferred into the breast.
Fat transfer can be useful for:
restoring modest breast volume
correcting asymmetry
improving breast contour
refining the results of previous breast surgery.
It generally produces a smaller increase in volume than breast implants, and some of the transferred fat will naturally be reabsorbed.
For the right patient, however, it can provide subtle volume enhancement using their own tissue.
During the consultation Mr Herieka will explain your options, the pro’s, the con’s and the cost of each approach.