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Background:  The bodies of all women are affected by the tissue stresses that pregnancy causes. While some women have good skin elasticity and their bodies bounce right back into shape afterwards, this is more uncommon than common. Loss of breast volume and stretched out skin causes loss of a once perky breast shape to one with varying degrees of ptosis. (sagging) The tummy area develops loose skin and more lax abdominal muscles. These breast and abdominal changes combined with some weight that can not be easily lost makes for a mommy’s body that may be in need of a makeover.

Hispanic patients make up an increasing segment of American plastic surgery and women make up the vast majority of these ethnic patients. The shape of the body and a keen sense of fashion are important cultural influences in this society, even more so than in most American Caucasians. Having perky breasts, a flatter and tighter abdomen and more rounded buttocks gives the Hispanic body more curves and appeal. Thus the growing numbers of Hispanic women who undergo breast augmentation, tummy tucks, liposuction and buttock enlargement.

There are some unique aspects of any plastic surgery procedure in Hispanic patients, including the Mommy Makeover. Hispanic skin is almost always thicker with more pigment-generating cells. While their thicker skin is far less prone to wrinkling and sagging than skin of Northern Europeans and Scandinavians for example, this is really only relevant in the face. Their more mesomorph-like body types are prone to fat accumulations and their breast and abdominal skin is easily stretched out and made loose. Their skin type makes it prone to potential unsightly scarring and changes in skin tone around the incisional area.

Case Study: This 33 year-old Hispanic female wanted to improve her body after having two children. Her breasts had lost volume and had some very slight  sagging. Her abdomen had considerable  loose skin and stretch marks with a deformed belly button and muffin tops at her sides. She was at a reasonable weight of 134 lbs at 5’ 4” tall.

Under general anesthesia, her Mommy Makeover took 4 ½ hours and was done as an outpatient. While implants and a vertical (lollipop) breast lift would have given her the most uplifted breasts, I did not feel the scars in her skin type was a good aesthetic trade-off. Larger silicone implants of 400cc in size were placed through small lower breast crease incisions but with emphasis on lowering her current breast fold to create a ‘pseudolifting’ effect. Concurrently, a full tummy tuck with liposuction of the flanks (side of the waistline) and upper abdomen (side of the waistline) was done with muscle plication and the creation of a new belly button shape. The fat harvested from the abdomen was processed and then injected into the buttocks with a total of 200cc per side.

Mommy makeovers in Hispanics must factor in one important consideration, the scar burden. Scars from most body contouring procedures are hard to avoid if good results are to be obtained and there are little alternatives to the benefits of a tummy tuck. But at least the scar can be reasonably hidden. The breast is different and any scar that wanders off of the areola should be avoided if possible. This may necessitate the use of a larger implant and a smaller breast lift to help pick up some the sagging.

Case Highlights:

1) Pregnancy creates permanent changes to the breasts and abdominal area, always associated with loose and often extra skin.

2)  Mommy makeover surgery consists of differing forms of breast enhancement and abdominal/waistline tightening.

3)  Hispanic women undergoing breast and abdominal surgery pose a higher risk of more prominent scar concerns even though they need the same types of body contouring procedures. They may also benefit by concomitant buttock augmentation by fat injections.

Dr. Barry Eppley

Indianapolis, Indiana

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