15:05 (GMT+2), Wed, 14 September 2011
After you've had kids, there seem to be those extra kilos that just won't budge, irrespective of how many hours you spend in the gym, and despite your disciplined avoidance of carbs. It can be tempting, therefore, to resort to a nip and tuck. We spoke to a Johannesburg-based plastic and reconstructive surgeon, who revealed which popular surgeries can help restore mom's physique to its former glory.
Remember, plastic surgery is to fix those problems that you can't fix naturally.
"Any form of body contouring should only be done when you're at a stable weight, when you're no longer lactating and your breasts have settled, and when diet and exercise aren't working anymore," advises the surgeon.
Breast augmentation (±R35 000)
Breasts are an important part of a woman's identity, and often, once you've experienced the fuller breasts that come with pregnancy, it's hard to go back to a smaller size.
During a breast augmentation, a surgeon inserts an implant in your breasts to make them bigger and more shapely. There are six decisions that you'll need to make before you have this procedure done:
1. Silicone or saline: All implants have a silicone shell, but you need to decide whether you want this shell filled with silicone or saline. The benefit of a silicone implant is that it's more difficult to feel the edge of the implant, and so many people believe that these feel more natural than saline implants. However, if your implant ruptures, saline will be absorbed harmlessly into your body, whereas a silicone leak could lead to problems like silicone granulomas, (inflammation of the breast tissue), as well as scarring and capsular contracture (when the socket that was created for the implant tightens, making the implant feel hard and sometimes distorting the appearance of the breast).
2. Whether you'd like the incision to be made in the armpit, the areola or the breast. Each of these areas has advantages and disadvantages, but all of them leave a scar.
3. The implant position: implants can either be placed under your breast tissue or underneath the muscles of your chest wall.
4. Whether you'd like textured or smooth shells.
5. The size you'd like to be.
6. The profile you'd like; "low profile" implants have less projection and look more natural, while "high profile" implants will give you more cleavage.
Your surgeon should talk you through each decision, helping you make the correct choices for your own body shape. Bear in mind that a breast augmentation is painful. For the first few days after your operation, you'll need to sleep on your back with your head elevated on two pillows. Your new breasts will also need to be supported for six weeks after the procedure.
Breast lift (±R30 000 – R40 000)
Gravity, pregnancy and breastfeeding cause your skin and breast ligaments to stretch, which, in turn, cause your breasts to sag. A breast lift, or mastopexy, will lift and tighten your breasts, making them appear more youthful.
The operation takes between one and two hours. Incisions will be made around your areola, and down to the fold of your breasts. These incisions will leave permanent scars. Excess breast skin will be removed, the skin over your breast will be tightened, the nipple will be returned to its natural position, and your breasts will be reshaped. A small drain may be inserted to drain excess blood and fluid, which will be removed one to three days after your surgery.
Remember, it's probably best if you wait until you're sure you won't have more children before you have this procedure as pregnancy and breastfeeding will reverse the effects of the surgery.
Breast reduction (±R34 000)
Large breasts can be uncomfortable. Not only can they cause backache and muscle tension, but they can also give you rashes underneath your breasts. Breast reductions often make women more proportional and comfortable, and after a reduction, it's easier to find better-fitting clothes and to participate in sports.
Before the surgery you'll decide, with the help of your surgeon, on how much breast tissue needs to be removed, and the new position of your areolas and nipples. You may also need liposuction for any excess fat under your armpits. Once the surgery is complete, a drain will be left in each breast to remove excess blood or fluid, and will be removed a day or two after your surgery.
A breast reduction will leave you with scars around your areola to underneath your breasts. You may also lose feeling in your nipples (although this does usually resolve itself a few months after surgery) and, because the surgery removes many of the ducts leading to the nipples, you might not be able to breastfeed once you've had the surgery. Most of the swelling and bruising will go down within the first few weeks, but it can take anywhere from six months to a year before your breasts settle into their new shape.
Tummy tucks (±R30 000)
After pregnancy, especially if you've had several children, your vertical abdominal muscles lose their tone. The only way to get these muscles tightened to their full pre-preggy state is by having a tummy tuck or an abdominoplasty. A tummy tuck can tighten these muscles and remove any excess skin, scars and stretch marks found below the belly button.
During surgery, an incision will be made just above your pubic area, and a second incision around your belly button. Your abdominal skin and fat will be separated from your abdominal wall, all the way up to your ribs. Your abdominal muscles will then be tightened with strong stitches, which will narrow your waistline. Any excess skin and fat will be removed, the rest of your abdominal skin will be stretched downwards, and your belly button will be stitched into its new place. The surgeon might also do liposuction to improve the final shape. (This procedure describes a major tummy tuck. Mini tummy tucks require smaller incisions, and your belly button won't be moved.)
You'll be left with a permanent scar – usually hidden in your bikini line – that will extend from hip to hip. There will also be a scar around your navel. It's best to wait until you're sure you don't want anymore children before having a tummy tuck, because pregnancy will stretch your abdominal muscles again, and the scars and stretch marks that were removed during surgery will return.
Liposuction (±R15 000 – R35 000)
It's important to realise that liposuction is not a procedure intended for weight loss. It also won't get rid of your cellulite or tighten loose skin. In fact, the best candidates for liposuction are those people who have a normal height-to-weight ratio, but just have pockets of fat that diet or exercise won't get rid of.
During surgery, the tube that will be used to remove your fat, known as a cannula, will be manoeuvred deep within the fat layers under your skin and moved backwards and forwards to break up the fat. Tunnels are created through which the fat can be sucked out.
It takes three to six weeks for swelling to go down before you'll begin to see your new shape. However, it takes as long as 18 months for swelling to fully subside.
The great thing about liposuction is that, provided you exercise and eat sensibly, you probably won't gain fat in those areas again, and if you do, it will probably be spread more uniformly over your body.
Designer laser vaginoplasty (±R20 000 – R35 000)
It's rarely talked about, but the area of a woman's body that's most affected by childbirth is the vagina. Having a natural birth can cause your vaginal muscles to lose their tone, which, in turn can lead to incontinence or the loss of sensation in the vagina, affecting the amount of pleasure you experience during sex. Natural birth can even cause the outer appearance of your vagina to change, for example, your labia can become longer or lose elasticity, or the edges of your vagina can become darker.
Dr Julian Bassin from the Netcare Linksfield Hospital specialises in a procedure known as designer laser vaginoplasty (DLV). With this procedure, all of the above-mentioned changes can be corrected.
When you go for DLV, the surgeon will do a digital examination of your vagina. He will then talk about what the procedure can achieve. Julian explains that a laser is used because it's a precision-cut instrument, which minimises bleeding and bruising. "The laser is used to open the upper and lower portions of the vaginal mucosa (the mucous membrane inside the vagina) in order to get to the underlying support tissues and muscles. These are then brought back together with absorbent suture material." Any excess vaginal mucosa will then be surgically removed, and the new edges of your vagina stitched together. This will make the inside diameter of your vagina smaller. If needed, the muscles of the outer part of your vagina, known as the perineal body, can also be adjusted. "This will build up and strengthen this area, which effectively decreases the external diameter of your vagina," explains Julian.
You'll be able to drive within ten days after your procedure, and you can have sex again once all the sutures have dissolved – about six to eight weeks after the procedure. Complications with the surgery are very rare, although infection and haemorrhage are the ones that surgeons guard against most. "Decreased sensation is a theoretical risk, but in reality, our patients laud the increased sensation," adds Julian.
Remember, although it's still possible to fall pregnant once you've had DLV, pregnancy and childbirth will reverse the effects of the procedure, so it's better to make sure you don't want any more children before you have the procedure.
We've had it done!
Megan Hartwig, mom to Zoe (six years old) – breast augmentation
Before I even had my daughter, I was always self-conscious about my breasts being so small (size 32A). So when I fell pregnant in 2003, I enjoyed having larger breasts for a change. That's when I decided that I wanted to have a breast augmentation. After I'd finished breastfeeding my daughter Zoe, I had my breast augmentation in December 2005, when Zoe was 18 months old. It was the best thing I could've done! My confidence levels have sky-rocketed and I don't feel so self-conscious anymore.
Anonymous, mom of three – breast augmentation and tummy tuck
I had a horrible flap of skin which refused to budge no matter what exercises I did! My breasts were also damaged from breastfeeding. So I saw a wonderful plastic surgeon who did a mini tummy tuck and breast augmentation for me. The post-op recovery was very easy; I didn't have any pain from the tummy tuck although I did have sore breasts for up to a month afterwards. My doctor put in implants just large enough to fill the empty skin, so no one noticed the enlargement. My tummy is now as flat as it was when I was a teenager, and I love it.
Anonymous mom – designer laser vaginoplasty
I had a very complicated natural birth, which left my vagina loose, with lots of scar tissue. After giving birth, I thought my vagina would tighten naturally, but it didn't. A deep sense of shame accompanied sex. I tried doing Kegel exercises, and even went to physiotherapists to try to re-tighten my vagina, but nothing worked. Last year, I went for the DLV operation, and it's the best thing I ever did. Although I was initially concerned about being unable to lubricate properly and reach orgasm, sex is now better than ever! There's been no pain or discomfort, and I would recommend the procedure to anyone.
How to choose a surgeon:
• Choose a properly trained plastic and reconstructive surgeon, and not a GP who claims to be able to do plastic surgery – it may cost you a bit of money, but rather pay more and be safe.
• Your surgeon should be registered with the Association of Plastic and Reconstructive Surgeons of Southern Africa (APRSSA): www.plasticsurgeons.co.za.
This way, you know that he/she has undergone accredited training and, if you feel that your surgeon hasn't treated you properly, you do have recourse – the APRS has an ombudsman who can mediate between you and your surgeon.
• Referrals from either your GP or from other women who've had work similar surgery done, are useful.
•Trust your instinct – make sure you get along well with your doctor and that you trust him.