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.