I would have to say that that the largest group of patients I see in my daily office life are post partum moms. It is a very consistent group of people with similar requests. The post partum moms usually have very realistic goals. They want to restore the breasts that fell or flattened after child bearing and tighten the tummy that now jiggles, bulges or droops. For purposes of this article I will focus on the tummy.

The group of people described above is usually well read, well researched and in good physical shape. So into my office walk a group of women who are trying to do everything right with diet, exercise etc. and they wonder why their tummies are not behaving. About 80% of these women come in looking for liposuction. This is where the education begins. While in some cases it might be OK, for the majority liposuction is not the right answer.

The post partum tummy has a few things going on. First, the hormones associated with pregnancy have literally allowed the deep tissues of the abdominal wall to stretch. Second, the midline muscles (abs) spread to the side leaving a gap between them called “diastasis.” Lastly, the overlying skin has stretched, usually beyond the point where it can fully recoil like a spring that has been pulled too far.

A patient like this can do everything right with exercise, diet, and good nutrition, but despite her best efforts the loose abdominal wall won’t shrink back. The muscles won’t come back to midline and with weight loss the skin will usually become looser. It seems very unfair.

When these patients come to my office wanting liposuction I explain that liposuction makes the loose skin looser, not tighter and that’s when they realize I’m about to embark upon a discussion of the thing they hoped I would not bring up…. the dreaded tummy tuck. Nobody really wants it, they are hoping that I will have a laser or lotion that will shrink up the loose skin, but unfortunately in this year of 2011 a tummy tuck is still the most predictable option for the loose post partum belly. About every 6- 12 month a new laser is released or cream promoted that can wipe away the loose skin, but if it worked I would be doing it.

So what does the tummy tuck do? It allows us to balance or tighten the muscles, flatten the abdominal wall, throw away loose skin and often stretch marks. Liposuction can’t tighten the muscles or flatten the abdominal wall. Yes, it leaves a scar which daily I try to hide or minimize. There are different types of tummy tucks depending on how loose you are– full, mini, fleur de lis and even those I do sometimes without tightening the muscles. An evaluation and a pinch of the skin will help determine which option is best.

So sometimes even if you are doing everything right, the skin, the tummy may still misbehave and your best bet may be a tummy tuck. What about the breasts that fell or flattened? That’s another article.

Dr. Adam Tattelbaum is a Board certified plastic surgeon. He has offices in Rockville, Maryland, Annapolis, Maryland and Mclean, Virginia. You can visit his web site at www.atcosmetics.com. Please feel free to contact us to make an appointment.