Initially if someone had suggested that a tummy tuck can be a cure for persistent back pain, I would have been highly skeptical. However, over the years I have performed a number of tummy tucks on women who had developed back problems after pregnancy as described above. Interestingly, virtually all of these women had either significant improvement or complete resolution of their back pain.

A Case Study

Recently, I performed a Mommy Makeover on a woman who had had triplets. She was not overweight but the pregnancy had caused significant changes in her body. After pregnancy she had developed nearly constant back pain. She had taken over the counter medications, undergone physical therapy, acupuncture, and on occasion even narcotic based pain medications to control her back pain. She is a part of an internet forum of women who have had triplets and several of them have similar back issues. She asked for a tummy tuck (as well as a breast lift) to improve the appearance of her stomach and she hoped that it might also help her back. While I was confident of an improved look for her stomach, I made it clear that I had only a marginal hope that a tummy tuck would offer any improvement to her back pain.

This mother of triplets is now 6 months out from her tummy tuck. Not only is she pleased with the cosmetic improvement of her stomach, she has in addition not experienced even one day of back pain since the surgery. Although this result may not be typical, she informs me that many of the women who participate in her triplets forum have had the same experience.

What’s the Verdict?

Clearly more research is needed to determine if there is a consistent improvement in back pain after a tummy tuck. It’s definitely a topic of discussion in certain forums and social posts, and has helped some women who have significant stretching of their stomach wall muscles. What a great situation – at least some women can benefit both cosmetically and improve their back pain from a tummy tuck.

Breast Sagging after Pregnancy

Because the breasts normally swell with milk immediately after pregnancy, many women find that their breasts undergo a significant, albeit temporary, increase in size. This size boost can stretch out the breast skin, and after milk production has stopped and pregnancy hormones have returned to their normal levels, the stretched-out skin can create a deflated appearance, leading to breast sagging.

A breast lift is a surgical procedure that reshapes the breast tissue and lifts the breasts to a higher position. Finally, a breast lift tightens and smoothes breast skin while excising any extra, creating a perkier, more youthful figure. The sagging that can result from pregnancy and nursing makes a breast lift one of the most popular procedures to include in a mommy makeover.

Is a Breast Lift Right for You?

Not every woman wants or needs a breast lift. Many women instead choose breast augmentation with implants to replace lost volume, while others combine breast enhancement procedures. It’s important to time your mommy makeover for the best results and talk to your plastic surgeon about your cosmetic goals before making any final decisions about your new look.

• Round implants are circular on the back. The larger sizes have larger diameters and they tend to have a half-moon shaped profile. The amount that a round implant “sticks out” (projection) varies between moderate (flattest), moderate plus or high profile (has the greatest projection). Each of these profiles has particular advantages for a woman depending upon her build, breast geometry and desires for the final look.
• Shaped or “teardrop” implants are generally taller than they are wide and they are fuller in the bottom portion of the implant. There is an array of implant shapes available with differing height to width ratios. Some may even be wider than they are tall. Each of these combinations is suited to one particular breast shape or another.

Making the Choice

So who should get a shaped breast implant and who should get a traditional round breast implant? Most importantly go with the recommendation of your American Board of Plastic Surgery certified plastic surgeon. He/she is interested in your getting the best result possible and will advise you how best to accomplish that. There are, however, some considerations that come into play.

Shaped breast implants tend to be slightly firmer than round implants. Shaped implants tend to give the upper portion of the breast a smoother transition from the chest to the upper portion of the breast. The slight increase in firmness of the shaped implant helps maintain the fullness of this upper portion of the breast and resists the effects of gravity. The upper portion of round implants tends to collapse downward slightly from the effect of gravity. Thus there is a slightly more noticeable transition from the chest to the breast.

The greatest benefit of shaped implants is in breast augmentations in very small breasted women. In these cases, the shape of the implant contributes to the shape and form of the breast. In situations where there is a large amount of breast tissue compared to the size of the implant, the benefit of the shaped implant is decreased.

One of the disadvantages of a shaped breast implant is that it has the possibility of rotating within the pocket created for the implant. If the rotation is significant this may be visible. The risk of this happening should, however, be very small. A plastic surgeon skilled in the placement of shaped implants should have no trouble creating a pocket for the implant which will hold the implant in a stable position and minimize the risk of implant rotation.

How Textured Implants Got Started

Originally, all breast implants were smooth on the surface. One of the most common issues with breast implants was their tendency to develop capsular contracture, which is a thickening and tightening of the thin layer of scar tissue around the breast implant. Many techniques were tried to reduce this scar tissue layer. One theory that developed was that texturing the surface of the implant would allow the surface of the implant to interact with the scar tissue layer and decrease its thickness and tightness.

Textured Implant Benefits

Evidence has shown that when the implant is placed directly beneath the breast (on top of the chest wall muscle), the likelihood of capsular contracture is decreased when using a textured implant. It is not clear that the same benefit exists when a textured implant is placed underneath the chest muscle. In cases where implants are under the chest muscle there seems to be some benefit in reducing the risk of capsular contracture simply by having the implant in a submuscular location. Capsular contracture rates are improved but are not notably different between textured or smooth implants when using submuscular placement.

Textured Implant Drawbacks

One of the disadvantages of texturing is that it tends to increase the risk of visible rippling or implant surface waves that can be seen through the skin. This is a particular problem associated with saline implants in smaller breasted women who have their implants over the chest muscle. Visible rippling is less of a concern with silicone implants and less of an issue with women who have ample breast tissue to pad or camouflage the implant. Rippling also is uncommon when the implants are placed under the chest wall muscle.

Making the Choice

So who should get textured implants? All women who have breast augmentation with shaped breast implants will automatically get a textured implant. Currently all the shaped implants are only available with textured surfaces. The reason for this is that the texturing also tends to hold the implant in position a little better. Since the shaped implants could potentially rotate within their pocket, the texturing decreases this likelihood and thus for these implants provides a more reliable result.

Round implants may be either smooth or textured. Every plastic surgeon will have his/her opinion as to the best situations to use textures or smooth breast implants. Since textured implants, in my opinion, tend to show rippling easier and since this is already an issue with saline implants, I tend to avoid this saline/textured combination when placing implants over the chest muscle – especially in smaller breasted women. When placing an implant beneath the chest muscle, I also tend to use a smooth surface implant since there does not appear to be any significant advantage to a textured implant in this position.

Nevertheless, women who have recurrent capsular contracture and who are changing implants would, in my opinion, benefit from the use of a textured implant placed in a submusclular position.

The choice of having the breast implants placed in a subglandular (above the muscle) location or in a submuscular (beneath the muscle) location is something that many women are concerned about. Although it is generally wise to follow the recommendations of your plastic surgeon, it is helpful to understand some of the reasons for selecting one location or the other.

In the eyes of most women, the prettiest breast augmentation is one in which the breasts do not look obviously augmented, but instead appear naturally larger. If the edge of the implant or its contour is visible, the appearance of the breast is less natural. Conversely, if you cannot see the outlines of the implant, then the breast tends to appear naturally larger without the “augmented” look.

This is easiest to accomplish when the implant is well covered by an adequate padding of tissue. The thinner the tissues over the implant, the more it looks like an implant is present. For example, a basketball covered with a sheet, looks just like a basketball covered with a sheet. But a tennis ball covered by a comforter will just look like a bump in the comforter. The more cushioning between the implant and the skin, the less it looks like an implant.

One way to increase the padding over the implant and camouflage its presence is to place the implant “under the muscle.” The muscle referred to here is the pectoralis major muscle. This is the muscle on the chest that body builders develop and the muscle used to do push-ups. When the breast implant is placed under this muscle, it will cover the upper portion of the implant and the portion closest to the breast bone. This is the area most commonly exposed in swimwear and V-neck sweaters.

It is not necessary, however, that all women have their breast implants placed submuscularly. Many women have enough natural breast tissue so that placing the implants under the muscle offers no additional cosmetic benefit. This is especially true when using silicone implants. Further, there is some additional discomfort in the first few days after surgery with a submuscular augmentation.

Silicone implants are softer than saline implants and tend not to be as visible as saline implants. Furthermore, silicone implants tend not to ripple. Rippling occurs when the surface of the implant develops waves in it and these ripples are visible on the surface of the breast. Rippling is a common problem for saline implants; so much so that I rarely place saline implants over the muscle in a subglandular location. Rippling is rarely visible with an under the muscle breast augmentation.

An additional benefit to a submuscular breast augmentation is that the tendency for the development of capsular contracture with the implants placed under the muscle is less. Although the risk of capsular contracture is small and having the implants under the muscle decreases the risk by only few percentage points, sometimes placing the implants under the muscle to minimize the risk of capsular contracture may be important. This is especially true in cases of recurrent capsular contracture.

In the end, it generally best to follow the recommendations of your plastic surgeon. Your surgeon wants you to get the best result possible and will make recommendations based on their experience and your body/breast characteristics.

A small number of the women who have breast augmentation can develop a malposition of the breast implant(s) called symmastia or synmastia and is sometimes known as “uniboob.”

Symmastia occurs when the breast implant pockets extend too far centrally over or across the breast bone. Sometimes both breast implant pockets may even join together in the middle creating one large pocket. This allows the implant to shift over the breast bone (sternum) creating a fullness in the middle and a distortion of the breast shape. The breasts may appear to be joined in the middle with loss of cleavage.

Symmastia is an uncommon occurrence after breast augmentation. It may be caused by choosing implants that are too large for the amount of skin that is available. This leads to excessive tension on the tissues over the breast bone from a large implant pulling the skin forward and off of the chest wall. It may be sometimes be caused by excessive pocket dissection centrally at the time of surgery. Fortunately, it is a condition that can be corrected.

Breast revision surgery can be performed to reposition the breast implant pocket so that the implant is centered behind the breast and the nipple. At the same time, the portion of the breast implant pocket that extends too far centrally is closed off to prevent the implant from shifting in this direction. Closing off this portion of the pocket also returns the skin and tissues back down to the chest and breast bone, re-establishing both cleavage and an appropriate space between the breasts.

In the past, many surgeons have recommended that the implants be removed during the recovery and healing process after correcting the symmastia. This was to prevent the weight and movement of the implant(s) from destroying the synmastia repair before it had a chance to heal properly. After satisfactory healing had taken place, breast implants could then be replaced. Unfortunately, this was a two-step process which required purchase of additional implants.

Dr. Nein has had great success in treating cases of symmastia with a one stage procedure. This repair does not require (in the vast majority of cases) a second procedure and does not require removal of the implants for a period of time. Using a biological mesh material (SERI) to reinforce the breast revision adds strength and stability. The SERI is placed internally over the repair. The SERI is eventually reabsorbed by the body but leaves behind a strong layer of tissue to hold the implants in place. This additional strength allows Dr. Nein to perform the entire operation in one step, saving expense and recovery time. For additional questions about synmastia repair please contact our office at 615-327-0201.

In almost all cases, when a woman lies on her back her breasts (and implants) shift to the side. But if the implants shift too far to the side, it can distort the shape of the breast. The implants should be centered behind the breast and nipples and they should maintain this relative position when a woman moves. If the implants shift too far to the sides, the nipples tend to point towards the middle, the sides of the breasts bulge outward and the space between the breasts widens dramatically and flattens out. Occasionally, this movement may also be uncomfortable and some women may feel self-conscious about their breast appearance.

Excessive movement of breast implants behind the breasts is generally the result of the implant pocket being too big for the implant itself. This provides too much room for the implant to move and allows it to shift out from behind the central portion of the breast. Most commonly, this is caused by the implants being too large or heavy for the breast tissues to support and hold in place. As time goes by, continued pressure on the breast tissue causes it to stretch and expand the breast implant pocket. Less commonly, an excessively large breast implant pocket can be the result of over-dissection of the pocket at the time of augmentation.

Fortunately, this situation is uncommon and can be treated. A surgical procedure known as a capsulorrhaphy can correct this problem. This procedure tightens the breast implant pocket, decreasing the mobility of the implant within the pocket and re-centers the implant back behind the breast and nipple. This can often be done without having to remove the implants during the healing phase and then returning to the O.R. to place new breast implants. After surgery it is important, however, that every effort be made to keep the weight and pressure of the implants from straining the breast pocket repair and causing it to fail. Usually wearing a bra that holds the breast together and away from the sides for about 6 to 8 weeks will be adequate. The bra should be worn throughout the day and especially at night when the curvature of the chest tends to allow gravity to pull the implants back to the sides.

It may be difficult to keep the weight of the implants off of the breast pocket repair when the breast implants are large and heavy. In such cases, a biological mesh (such as SERI) may be used to reinforce the capsulorrhaphy and minimize the risk of failure of the repair. The mesh increases the strength of the repair and over many months it is slowly reabsorbed by the body and replaced with natural tissues. These tissues are quite strong and continue to provide excellent support for the implant so that widening of the breast implant pocket does not recur.

Dr. Nein has treated a number of women who have been referred for treatment of breast implants that are too far apart. The advanced techniques he has used to correct these deformities have proven to be very successful. These women have been very pleased with the repositioning of the breast implants and after complete recovery are able to lie back without being embarrassed about their breast movement. These procedures are performed as an outpatient and recovery is similar to the initial breast augmentation.

Implant malposition can lead to implants being too low: sagging, bottoming out or double bubble appearance. Sometimes they can be too close – symmastia, synmastia, uniboob. Another possibility is that they shift too far to the sides especially when lying flat. When this occurs, the nipples tilt inward, there is excessive fullness towards the side of the chest and flattening and widening of the space between the breasts.

Ideally, breast implants should be positioned so that the center of the implant sits directly behind the nipple. The implants should maintain this relative position regardless of whether you are standing up or lying down. When the implants move excessively behind the breasts, then malposition can occur. This is most commonly the result of the breast implant pocket being too large for the implant and sometimes the entire pocket is not in the correct position. When this occurs the implant does not maintain its position behind the breast and the nipple. The malposition of the implant can distort the shape of the breast.

Each of these conditions can occur individually or in combination on one or both sides. Fortunately, it is treatable with a surgical procedure to revise the breast implant pocket. In simpler cases it may be possible to modify the pocket and place some stitches in the area where the pocket needs to be tightened. In more complex cases, it may be necessary to add a biological mesh such as SERI to assist in holding the implant(s) in the proper position.

Dr. Nein has treated a number of women who have been referred for treatment of implant malposition. The advanced techniques he has used to correct these deformities have proven to be very successful. These women have been very pleased with their results and have been able to return to wearing the clothing of their choice without having to cover-up or camouflage previous breast asymmetries. These procedures are performed as an outpatient and recovery is similar to the initial breast augmentation.

1. Are Your Abdominal Muscles Separated?

The state of your abdominal muscles can have an impact on your tummy tuck options. A full tummy tuck includes the repair of separated abdominal muscles, along with removing skin and fat from your waistline. Although a mini tummy tuck can include some degree of muscle repair, it doesn’t always, and that repair may not be significant. If only minor tightening is needed, you might be fine with a mini tummy tuck.

2. Is There Skin Laxity above Your Navel?

Skin laxity refers to the amount of stretching and sagging present in your skin. If you’ve noticed you have excess skin above your navel as well as below, a full tummy tuck may provide you with more comprehensive results that will tighten up your entire midsection. If your biggest concern is excess fat deposits located below your navel, a mini tummy tuck could well be enough to give you the results you need.

3. How Much Correction Do You Need Overall?

While both full and mini tummy tucks can provide excellent results, patients with only a little bit of stubborn fat to lose may find that a full abdominoplasty is more extensive than they need. For patients with small amounts of fatty tissue and problem areas located primarily below the navel, a mini tummy tuck may offer the perfect level of correction with a less invasive surgery and a smaller scar.

Occasionally, a woman who has breast augmentation can develop a shifting of the breast implant(s). Some of these cases result in the implants being too low on the chest wall. Generally this is result of the breast implant pocket being in the wrong position or the pocket being too large for the implant. Either of these situations can be caused by implants that are too large or too heavy for the breast tissues to adequately hold them in place. The excess size and weight can cause the tissues to stretch and allowing the implant to migrate down to an abnormally low position. Much less commonly, the fold at the bottom of the breast could have been damaged at the time of surgery and the bottom of the pocket dissected too low, resulting in an implant position that is unsatisfactory and giving what is sometimes referred to as a “double bubble” appearance.

Traditional techniques to repair an implant that has bottomed out, is too low or has a double bubble appearance have been difficult to do. The recurrence rates have been high and at times multiple operations have been necessary.

Dr. Nein has treated a number of women who have been referred for treatment of implants that have dropped and become too low. The success of these breast revision surgery operations has been quite good and recurrence rates extremely low. The use of a biological mesh such as SERI makes it possible to very, very low recurrence rates with even very heavy implants that normally would have a high risk of recurrent bottoming out. This mesh is used to reinforce the repair of the bottom of the implant pocket and support the weight of the implant. Over many months, the SERI is absorbed but leaves behind a strong layer of natural tissue which continues to support the implant(s) and strengthen the repair of the inframammary fold. These procedures are performed as an outpatient and recovery is similar to the initial breast augmentation.

For additional questions regarding breast implant surgery, breast revision surgery or breast asymmetry please contact Dr. Nein’s office at 615-327-0201 and we’ll be happy to help you.