The Core Issue: Is a “mommy makeover” right for you?
By Malia Jacobson
Like most new moms, Olya*[i], 31, expected her body to change after pregnancy and childbirth. But the mom of two from Bellevue didn’t anticipate how drastic the transformation would be: Six months after giving birth to her second child, now 1, she still looked six months pregnant. Sort of—her belly wasn’t the evenly round bump one might sport while pregnant; it slanted to one side and featured a protruding belly button that looked like the end of a half-inflated balloon.
She felt cosmetically disfigured, she says, but that wasn’t the worst part. Every day, she fought through lower back pain, achy numbness in her legs, and debilitating fatigue. “By the end of the day, I couldn’t even stand up,” she says.
Worried that something might be seriously wrong, and unable to keep pace with her active young kids, Olya made an appointment with her OB-GYN. After a brief physical exam, her doctor suspected diastasis recti, or a vertical separation of her lower abdominal muscles, as well as an umbilical hernia near her bellybutton, resulting from damage to the abdominal wall sustained over two pregnancies. Unable to support her lower back and internal organs properly, her compromised core was causing her back pain, leg pain and weakness.
The bad news: All the sit-ups in the world wouldn’t help Olya regain her pre-pregnancy abs, because the strain of pregnancy had forced the muscles to separate beyond the point of self-healing.
The good news: There was a fix. Her doctor recommended a multi-step treatment that included an abdominoplasty, or tummy tuck, surgical reconstruction of her abdominal wall muscles to repair the diastasis recti, and hernia repair, a package of distinct surgical treatments known collectively as a “mommy makeover.”
Fixing the floor
Olya’s not alone, or even close to it. Problems related to the pelvic floor, a hammock-like layer of muscle and connective tissue supporting the uterus, vagina, and bladder, are incredibly common, experienced by a third[ii] to a half of women. Tears and openings in the abdominal wall, like Olya experienced, are less common—about 200,000 women experience diastasis recti each year—but can wreak havoc on a women’s physical appearance and quality of life.
Enter “mommy makeovers,” or surgical packages designed to help moms regain their pre-baby bodies after childbirth. They can include the surgeries recommended to Olya for abdominal repair, along with a breast augmentation, breast reduction, plastic surgery to reshape the belly button, and vaginal rejuvenation (vaginal tightening) surgery.
Another reparative option for moms: Surgery to correct prolapsed (collapsed) pelvic organs including the uterus, bladder, and vagina, which can cause pelvic pain, urinary incontinence, or pain during sex.
Although post-childbirth restorative surgery has been trending for years—per the American Society of Plastic Surgeons, demand for tummy tucks increased 85 percent between 2000 and 2010—surgeons are seeing a recent uptick in demand, and these days, more moms are interested. According to RealSelf, an online community and learning hub for information on cosmetic procedures, the number of women researching “mommy makeovers” on their site has jumped 32 percent in the last year.
These fixes cost a pretty penny: Because procedures like breast augmentation and vaginal rejuvenation surgery are considered elective, they aren’t covered by insurance. (Medically necessary surgeries like hernia repair and surgeries to correct prolapse are usually covered.) Per RealSelf, “mommy makeovers” cost an average of around $12,000, but can set patients back as much as $50K.
Therapy without bandages
Surgery is pricey, and any surgical treatment carries some risks like bleeding, infection, and scarring. What’s more, these surgeries are recommended for moms who aren’t planning any more pregnancies.
Moms who may want more kids, or who’d like to avoid the knife but want to regain pre-pregnancy core strength, may have another option: Non-surgical pelvic floor physical therapy. Though physical therapy, also called PT, can’t repair abdominal muscle tears or hernias, a 2016 Dutch study[iii] showed that PT using basic strengthening exercises can effectively treat mild pelvic organ prolapse, helping stop the drip of urinary incontinence and reducing or eliminating pelvic pain.
PT can yield some surprises—just ask Amber of Tacoma, who started pelvic floor PT when her second son, now 2, was six months old. She got the referral to PT to address some persistent pelvic pain; plus, she wanted to quit leaking pee when she sneezed. She expected to learn how to tighten her pelvic muscles, but it turned out her pelvic muscles were already too tense, which led to pelvic pain and urinary problems.
Her therapist used vaginal biofeedback—an electrical readout showing tension in her pelvic floor—to help her learn to relax those muscles. “Now, I’m always mindful of tension in my pelvic floor,” she says, “and I know what to do when symptoms flare up.”
Moms can self-refer to PT or talk to their OB-GYN or midwife about a referral. Treatment is often covered by insurance and generally takes place over a course of 3-6 sessions a few weeks apart, with exercises assigned as “homework” between sessions. Workouts include pelvic floor contractions (Kegels) but don’t end there—depending on a patient’s physical condition and goals, a therapist may recommend lunges, squats, or small, controlled movements like squeezing a rubber ball between the knees. Sessions are usually no longer than a typical doctor’s appointment—and moms can usually take their tot to appointments.
Women should know that it’s never too late to seek out pelvic floor physical therapy, says physical therapist Peg Maas, board certified women’s health specialist with Seattle’s Swedish Medical Center. “There’s not a window of time for addressing these concerns, even if it’s been years since you gave birth.”
As for Olya, her mommy makeover surgery took place last September. She’s still recovering—she says her recovery process has been more painful and longer than what she experienced after each of her two C-sections—but her back and leg pains are gone and her energy is back. At her six-month checkup, she was given clearance to “go out and live life,” she says.
“I want to be active with my kids. I want to play with them and chase them and lift them up. That’s what this was about, for me,” she says. “Recovery has been tough, but I would do it again.”