Dr. Lee's Blog

As I type, I am imagining the response to this title statement, "Huh?" However, this is actually peraphrased from a statement of patient of mine who has had a Mommy Makeover. This woman is a powerhouse athlete, and a mother of three who came to the office with questions about the status of her abdominal wall. A tiny woman to start, pregnancy had left her with a wide separation of the rectus abdominus muscles, a condition called rectus diastasis. Although she could hide this "mommy belly" in clothing, she felt that she could no longer exercise with the ease and comfort of prior to pregnancy (as if running 10 miles could ever been sen as easy or comfortable). What is often under appreciated is that rectus diastasis result in an imbalance of all the muscles of the abdominal wall including the internal oblique, external oblique and the transversalis. Without proper muscular alignment, good core stability and strength are difficult or impossible to achieve and maintain. Exercising becomes much less efficient and may even cause injury. Core strength and balance of core muscles is required to maintain the structural integrity of the back, hips and legs.

While patient of mine is, no doubt, pleased with being able to get back her pre-pregnancy body (with a bit extra up top) repairing her rectus diastasis has helped her back and other lower extremity pain and enabled her to return to the level of physical activity she enjoyed prior to pregnancy. She regrets only not having had the procedure 5 years earlier when she first started thinking about it. It is her belief that those 5 years were time that could have used better and more comfortably had she not been struggling against the physical limitations resulting from rectus diastasis and core instability. She maintains that abdominoplasty has given her back a quality of life now and will help her maintain her physical ability and comfort for the rest of her years.

As many of you know, I am huge fan of the cosmetic website Realself.com. This is a public forum for people to ask questions of a certified panel of aesthetic surgeons. I am one of the physicians responding to queries and I am really interested to see how frequently a posting is made trying to determine what bra size will be achieved with a certain reduction weight or with a certain implant size. I guess from the number of times this is posted that many surgeons are not answering this question well enough during the consultation so I thought I would share my approach here.

Firstly, bra size is not standardized but varies from manufacturer to manufacturer. The volume of the cup in Victoria's secret 34D will be very different then the volume of the cup in 34D Warners bra. Victoria's secret is selling "bigger is better" and Warners often caters to large breasted woman who might want to be smaller. Also, a 350cc implant will look one way on a 5ft woman wearing 32A and completely different on a 5ft8in woman wearing a 38A. So to ask "what implant size to I need to go from a 34A to a 34DD" is a question that is impossible to answer and any surgeon that tells you differently is, in my opinion, being misleading. I want patients to decide for themselves what volume feels right to help them achieve the body image they want. To that end, I send them home with an easy way to make an "implant" they can use to fill a bra larger then what they usually wear, to walk around with that filled bra to see how the weight feels on their shoulders, how the size fits in their clothing, whether they get different attention from people on the street, whether they like that attention. I promise you, most woman can decide on an implant size that suits their needs using this easy experimental approach. I provide some basic guidance with the range that they should try, and I will not put in implants that I believe will cause a physical problem with overstretching the skin. But it is my opinion that the most appropriate questions is "What size helps you look and feel the way you want to look and feel?" not "what bra size will I be?" With a little careful guidance any woman can pick the look that is right for her, and it has little bearing on bra size.

In the next Blog, I will discuss addressing breast size in reductions.

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