Post-Pregnancy Surgery

Post-pregnancy surgery is a planning term we use for patients who are considering surgery to address physical changes that have followed pregnancy and breastfeeding. The term covers different combinations of procedures, with the most common being abdominoplasty combined with breast surgery, although the specific procedures chosen depend entirely on the changes the patient is concerned about and on what’s anatomically appropriate for their situation.

Pregnancy produces real physical changes, and not all of those changes resolve in the months and years afterwards. The skin of the abdomen often doesn’t return to its pre-pregnancy condition. The muscles of the abdominal wall can remain separated in the midline. Breast volume and position frequently change, with some women left with smaller or more deflated breasts than they had before, and others with looser skin or a lower nipple position. Whether to do anything about these changes is a personal decision, and we’ll talk through what surgery can and can’t do for your situation before any decision is made.

The physical changes after pregnancy fall broadly into a few groups, and the procedures considered depend on which of these changes are bothering the patient.

Patients considering post-pregnancy surgery often have changes in more than one area, and they ask whether procedures can be combined in a single operation. The answer depends on which procedures are being considered, the patient’s overall health, and the practicalities of operating time, anaesthetic time, and recovery.

Combining procedures has the advantage of one anaesthetic, one hospital admission, and one recovery period rather than two or more. It can be more efficient in terms of time off work and overall cost. The trade-off is that the combined operation takes longer, the anaesthetic is longer, and the cumulative risk is greater than either operation done by itself. The recovery is also more demanding, particularly in the first two weeks, when the patient is recovering from two operations at once rather than one.

Whether to combine procedures or stage them across two separate operations is a judgement made at consultation. For some patients, combining is the right answer. For others, staging the surgery is safer or more practical. The decision is based on factors including the specific procedures involved, the patient’s overall health and lifestyle, the expected duration of the combined operation, and the patient’s preference about hospital time and recovery.

There’s no single right time to consider post-pregnancy surgery, but there are some general principles that affect when surgery is likely to produce a good result.

Most patients are advised to wait until they’ve completed their family before having surgery. This is because pregnancy after abdominoplasty can stretch the skin and muscle repair, potentially undoing some of the result, and pregnancy after breast surgery can alter the result of the breast operation. If you’re planning further pregnancies, delaying surgery until after you’ve completed your family is generally the safer approach.

Surgery is also generally delayed until breastfeeding has finished, because breast tissue continues to change while breastfeeding is ongoing and the post-breastfeeding appearance of the breast can take several months to stabilise. For abdominoplasty, weight stability is important, with most surgeons recommending that patients return to a stable weight that they expect to maintain before having surgery.

All these factors are individual, and we’ll work through what’s appropriate for your situation at consultation. Pregnancy after surgery isn’t dangerous (subsequent pregnancies are generally tolerated without difficulty after these operations), but they can affect the result.

Post-pregnancy surgery isn’t a single operation. The procedures are performed under general anaesthesia in an accredited hospital, and the operating time depends entirely on which procedures are being combined. A combined abdominoplasty and breast augmentation typically takes between four and six hours. A combined abdominoplasty, breast lift and breast augmentation can take six to seven hours or longer.

Most patients having combined procedures stay in hospital for two to three nights, with the longer stay reserved for more extensive operations. Compression garments are worn after abdominoplasty and surgical bras after breast surgery, and the specifics depend on which combination of procedures has been performed.

Recovery after combined post-pregnancy surgery is more demanding than recovery after either operation alone. The first two weeks involve tightness across both the abdomen and the chest, restrictions on lifting and arm movement to protect the breast surgery, and a generally restricted range of movement to protect the abdominal closure. Most patients describe the early recovery as challenging, with the help of family or a carer often making a substantial difference in the first week.

Help with childcare is important. Lifting young children is off the list for around six weeks, and arrangements need to be made for someone else to lift toddlers, carry babies and do bath time and pram lifting. This is something to plan for in detail before surgery, particularly if you don’t have family or friends available locally. Most patients with desk-based work are back after two to three weeks. Physical roles take longer, and the realistic timeframe for return depends on the combination of procedures performed.

Final results develop over several months as swelling settles and the tissues mature. Scars take 12 to 18 months to reach their final appearance.

Combined post-pregnancy surgery carries the cumulative risks of the procedures being performed, and the size of the combined operation means that some risks (including blood clots in the legs or lungs) are higher than for any of the operations done alone. The recognised risks include:

Some of the procedures combined under the heading of post-pregnancy surgery may attract a Medicare rebate when specific clinical criteria are met. This applies most commonly to abdominoplasty with documented diastasis recti and to certain breast procedures performed for documented physical symptoms. Cosmetic procedures generally aren’t covered. We’ll assess your likely eligibility at consultation and provide a written quote covering all surgical, anaesthetic and hospital fees.

Dr Henry Shepherd, BMed MD MS (Plast.) FRACS (Plast.) | Specialist Plastic Surgeon | AHPRA registration: MED 0001860545