Mommy makeover procedures, in detail

Breast augmentation

Breast augmentation places silicone implants to restore volume to deflated breasts. Dr. Erdal's default technique is subfascial placement — the implant sits between the breast tissue and the pectoralis fascia, supported by fascia rather than muscle. This avoids "animation deformity" (implant movement during muscle flexion) while providing better tissue coverage than purely subglandular placement.

• Incision: Inframammary fold (most common), hidden in the natural crease beneath the breast.
• Implant choice: Mentor, Motiva, or Polytech, with patient choice of brand at no additional cost. Round or anatomical, smooth or microtextured surface, profile selected based on chest measurements.
• Operative time: 60–90 minutes when performed alone.
• Drains: No drains used.

Breast lift (mastopexy)

Breast lift repositions the nipple-areolar complex and reshapes the breast skin envelope without adding volume. It is the right procedure when breast tissue is sufficient but has descended significantly after breastfeeding.

• Vertical (lollipop) technique: Most common, scar around the areola plus a vertical scar from areola to fold.
• Anchor (Wise pattern): Used for severe ptosis, adds a horizontal scar in the inframammary fold.
• Periareolar (Benelli): Limited application — only for very mild ptosis.
• Operative time: 90–120 minutes when performed alone.

Augmentation-mastopexy

Augmentation-mastopexy combines lift and implants in a single operation. This is the appropriate choice when the breast is BOTH deflated (needs volume) AND ptotic (needs lifting). It is technically more demanding than either procedure alone and requires careful intraoperative judgment about how much skin to remove and how the implant interacts with the lifted tissue.

Dr. Erdal performs augmentation-mastopexy frequently as part of mommy makeover. Implant size is typically conservative (220–320cc) to minimise tension on the skin closure.

Abdominoplasty (tummy tuck)

Abdominoplasty removes excess abdominal skin and fat below the umbilicus, repairs the abdominal wall, and recreates the umbilicus in its correct position.

• Incision: Low horizontal, hidden by underwear. Length depends on amount of skin to remove.
• Skin and fat removal: Excess tissue between the umbilicus and pubis is removed. Upper abdominal skin is then advanced down to close the gap.
• Diastasis repair: Internal sutures close any abdominal muscle separation.
• Umbilicoplasty: The umbilicus is repositioned through a new opening in the advanced skin. Dr. Erdal pays particular attention to creating a natural umbilicus contour rather than an artificial-looking opening.
• Closure: Multilayered with progressive tension sutures (PTS) which reduce seroma risk and decrease drain dependency.
• Operative time: 2–3 hours when performed alone.

Variants of abdominoplasty

• Mini abdominoplasty: Limited skin and fat below the umbilicus only; no umbilical relocation. For very localised lower abdominal excess.
• Full abdominoplasty: Standard procedure described above.
• Extended abdominoplasty: Incision extends laterally to address flank skin, useful after major weight loss.
• Fleur-de-lis abdominoplasty: Adds a vertical incision for patients with significant horizontal AND vertical skin excess (typically post-bariatric surgery).

Diastasis recti repair

Diastasis recti is a separation of the rectus abdominis muscles along the linea alba — extremely common after pregnancy, particularly twin pregnancies and large babies. Diastasis is not addressed by exercise; the linea alba is fascia, and stretched fascia does not regenerate.

Repair is performed during tummy tuck. Dr. Erdal uses continuous internal sutures (typically 2-0 nylon or PDS) running from xiphoid to pubis, plicating the medial edges of the rectus sheath. This restores the abdominal core, flattens the contour, and improves intra-abdominal pressure mechanics — patients commonly report better posture and less lower back pain after recovery.

For diastasis under 2 cm, repair adds little. For diastasis 2–5 cm, repair is essential for an acceptable abdominal contour. Above 5 cm, repair plus possible mesh reinforcement may be discussed.

Liposuction

Liposuction removes localised fat deposits using small cannulae through tiny incisions. In a mommy makeover context, it most commonly addresses:

• Flanks ("love handles") — the fat above the iliac crest that creates a "muffin top" silhouette.
• Lower back — the area immediately above the buttocks.
• Inner thighs — for patients with persistent thigh fat resistant to weight loss.
• Bra fat — the area at the side of the chest.

The combination of tummy tuck (front) plus flank and lower back liposuction (sides and back) is sometimes called "360-degree body contouring" and produces a dramatically improved waist-to-hip silhouette. Operative time for liposuction varies based on areas and volumes — typically 30–90 minutes added to the operation.

How procedures are combined

The combination matrix shows the typical components for each named combination:

For detailed pages on each combination:

• Breast Augmentation + Tummy Tuck
• Breast Lift + Tummy Tuck
• Tummy Tuck + Liposuction
• Full Mommy Makeover

Operative time, procedure by procedure

Each component has its own operative time, and those times are what set the ceiling on how much can responsibly be done in one anaesthetic. The figures below are the times described for each procedure above, performed on its own:

Drains follow the same logic. No drains are used for breast augmentation. For abdominoplasty, particularly with diastasis repair, temporary surgical drains are placed for 3–7 days to prevent seroma, and the progressive tension suture closure described above reduces drain dependency in selected cases.

Combined, a full mommy makeover runs 5–6 hours. Dr. Erdal keeps total operative time under 6 hours; if anatomical complexity would require longer, the operation is split into two stages, typically 6–12 weeks apart, rather than extended. The order of stages is set by the position the patient needs to be in: abdominoplasty and diastasis repair first with the patient supine, then 360° liposuction with the patient repositioned laterally or prone, then augmentation-mastopexy with the patient semi-upright, then closure and dressings.

Keeping the components in one operation means one general anaesthetic rather than three or four, and hospital and anaesthesia fees paid once — which is why the combined route costs less in total than staging the same procedures over a year or more (see cost and what's included). The anaesthetic itself, including how a 5–6 hour case is monitored, is covered in mommy makeover anaesthesia explained, and the evidence on combining procedures in is it safe to combine procedures. Preparation in the weeks before the operation is set out in pre-operative preparation.

What these procedures do not change

Each operation above has a defined mechanism, and that mechanism defines its limits. Knowing what is outside the scope of surgery is as useful as knowing what is inside it:

• Body weight. None of these operations is a weight-loss procedure. Liposuction removes small, stubborn pockets rather than large volumes, and abdominoplasty removes loose skin rather than body fat. Reaching a stable target weight is something to do before surgery, not a result to expect from it — see BMI, weight and candidacy.
• Stretch marks outside the resection area. Stretch marks that sit within the skin removed by the abdominoplasty go with it. Stretch marks above the resection area, on the breasts, hips or thighs, remain. The procedure improves pregnancy changes rather than erasing them, as discussed in when to have a mommy makeover.
• Skin laxity, if liposuction is used alone. Liposuction removes fat but not skin. On an abdomen with significant skin laxity, liposuction alone produces a worse result than the starting point — which is why the skin is addressed by abdominoplasty and the contour beyond it refined by liposuction. See tummy tuck with liposuction.
• Future weight change. Fat cells that are removed do not return, but the fat cells that remain — in the same area and elsewhere — can grow if weight is gained. Stable weight is what preserves the result.
• Volume, in the case of a lift; position, in the case of implants. A breast lift reshapes the skin envelope and repositions the nipple-areolar complex without adding volume. Implants add volume without repositioning the nipple-areolar complex. A breast that is both deflated and ptotic therefore needs augmentation-mastopexy, not one or the other.
• Skin ageing. Skin continues to age after surgery on its normal course. Scars mature and fade over months with the right aftercare — set out in scars and incisions — but the result is a new starting point rather than a fixed one.