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When Dr. Shari Brasner talks with women on the operating table about to undergo a cesarean, she often hears the same one liner. “Patients joke, ‘Hey, can you do a tummy tuck while you’re in there?’” says the Mount Sinai Medical Center obstetrician. But even if she could, Brasner tells Yahoo Parenting she wouldn’t – nor should any obstetrician. “Most OB-GYNs have zero plastic surgery training, and that’s what this involves,” she explains. “It’s a significantly bigger surgery than the name implies.”
The allure of emerging from the hospital with a baby and a flat stomach is tantalizing to be sure. Dubbed the “Victoria’s Secret C-Section” by some, electing to undergo abdominoplasty, also known as a “tummy tuck,” directly after a cesarean may not seem like a big deal, considering that you’re already opened up, so to speak. But it’s a far cry from the more common “mini tuck,” in which doctors deal with the skin only. Plastic surgeons brought in to do abdominoplasty after the obstetrician completes a c-section cut into muscle and do “major work on the abdominal wall,” Brasner explains. “I’ve talked the majority of patients who’ve been interested out of it. They weren’t considering the practical aspect of combining the surgeries at all. I’d say only a third of my patients who are thinking about it actually pull the trigger.”
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Abdominoplasty – the fifth most popular cosmetic surgical procedure in the U.S. for women age 30 to 39, according to the American Society of Plastic Surgeons 2013 annual report – requires an additional one to two hours in surgery on top of the typically hour-long c-section and involves sculpting muscle, tissue and skin, not to mention considerable blood loss. “You go home with drains and usually require a private nurse for a couple of days,” explains Brasner of the roughly $5,000 elective procedure, which is not covered by insurance in most cases. “It significantly complicates recovery at a time when the mother wants to go home and be primary caretaker of her child.”
The aesthetic result of piggybacking the procedures isn’t ideal either. A study published in the 2012 International Journal of Women’s Health found that only 48 percent of women who did the surgeries back-to-back were satisfied with the results nine months later. The rest? 18 percent developed wound infection, 9 percent experienced rupturing and the rest reported various complications including bulging. “Results in this study render this practice not recommended and not encouraged,” the researchers concluded.
What makes the whole thing so tricky is that the size of a pregnant woman’s body is so expanded, in part with additional water weight and blood, in preparation for childbirth. “The entire body shrinks after delivery,” L.A. plastic surgeon Dr. Grant Stevens tells Yahoo Parenting. “So if you launch into a tummy tuck right off of a cesarean section, you will likely under reset the skin because the excess skin will not be as apparent. Then after the woman goes on to lose the baby weight, three, six, months later, she’s going to be left with excess skin and the need for another tummy tuck.” Wait six months, Grant advises, to give the body a chance to get back to its pre-pregnancy state and strength.
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So why does anybody undergo this combo cut? “Those who do go ahead with it tend to be women who are aware of damage already there,” notes Brasner. “They’re on their third or fourth cesarean delivery.”
Still, in that situation, Grant says he would advocate for a “mini tuck,” taking a wedge of skin out above the previous cesarean section scar so as not to add any of the complications of muscle tightening or sculpting.
And both agree that the patient should wait until her last delivery. “If you’re going to do it,” says Brasner, “do it when you’re finished with childbearing so you’ll get the best long term outcome.”