Mommy Makeover

An Open Letter to Moms from Dr. Kulkarni

Dear Mom,

Welcome to the No Judgement Zone.

If you’ve arrived here, you’re likely at a point where you’re considering surgery for your breasts, belly, or labia. I want to take a moment to assure you that there is no room for judgement of women’s choices in my office. The topic of post-pregnancy body contouring can be controversial, and you may have people in your life who want to pass judgement. Those people are not welcome here. DC Plastic Surgery Boutique is a place built for women, by women… where we lift women up and meet them where they are. For some of you, surgery will be the right answer, and for others, it will not. Both of those choices are valid and will be celebrated.  We are here to listen to your concerns and educate you about the anatomic changes of pregnancy and all the options available to you.

I’ll be honest– I hate the term “mommy makeover.” I think it sounds cartoony and kind of condescending. Surgery is serious business, and to me, the term “makeover” implies that surgery is no different than a trip to the beauty counter or hair salon. The only reason I use those words on this site is because women looking for information about post-pregnancy body contouring frequently use “mommy makeover” as a search term. Okay, rant over, now let’s talk about post-pregnancy body contouring.

There are 3 areas that are typically affected by pregnancy and childbirth: breasts, belly, and vagina. Post-pregnancy body contouring addresses these areas in whichever combination is required for each individual patient.


Your breasts are made up of a series of passageways called ducts and lobules that are designed to produce and store breastmilk. The system of ducts comes together at your nipple where the milk exits through tiny holes. During pregnancy, breast size increases in preparation for milk-making. The ducts and lobules swell, breast skin stretches, and the nipples grow. If you breastfeed, your breasts increase and decrease in size multiple times every day as they fill with milk and release the milk. Once you stop breastfeeding, your breast tissue slowly decreases in size as the ducts shrink (a process called involution). I tell women to wait at least 6 months after breastfeeding to assess the state of their breasts, as they will change significantly during that time.

Some women, especially those who started with smaller breasts, may notice little change between their pre- and post-pregnancy breasts. Medium and larger-breasted women will notice more permanent changes in the size and shape of breasts. These are a few of the ways breasts can change after pregnancy:

  1. Decreased size: Involution of milk ducts can cause the overall size of breasts to decrease one or more cup sizes.
  2. Same cup size, but different shape: Many women have stretching of breast skin with pregnancy and nursing, resulting in breasts that are elongated in shape
  3. Loss of fullness in the upper pole: Some women have deflation of the upper part of the breast that gives the breast a flat appearance
  4. Stretch marks: Caused by the rapid increase in size that comes with pregnancy
  5. Increased size: Every once in a while, breasts increase with pregnancy and never go back down

There are several ways to surgically address breast changes, and the appropriate operation is selected based on your individual anatomy. Shrinkage and loss of upper pole volume can be addressed with breast augmentation (with implants or fat transfer). Breasts can be decreased in size with breast reduction or lifted by removing skin and repositioning the nipples. The nipples can be reduced in size as well.


Pregnancy obviously has a dramatic effect on your belly– maybe more than any other part of you! How much permanent change your body experiences is entirely dependent on your genetics and anatomy. I recommend that you wait a full year after your last delivery before assessing the state of your belly. Your body changes so much in that first year after delivery that you really want to wait to make any assessments until then.

In the first year after pregnancy, I strongly recommend that moms focus on rebuilding the mind-body connection that can be disrupted with childbirth, and re-establishing core strength. There are several exercise and physical therapy programs designed specifically for the post-partum body. Many of them work well, but I find the MUTU System to be the most comprehensive and easiest to follow. If you are within the first year after delivery, or you are past that time and looking for specific advice on how to rebuild your core strength, check out MUTU System. (PS- I don’t get anything for recommending this, I just think it’s a good system). Other options include the Tupler technique and Dia Method.  

Once a year has passed and you are at your goal weight with reasonable core strength, you can safely assess your belly. Many women will find that the combination of good nutrition, exercise, and core strengthening with a MUTU System or equivalent, gets them to a place where they are satisfied. If you have done all of the above and still feel dissatisfied with the appearance of your belly, then it may be time to start thinking about abdominoplasty (tummy tuck) with rectus plication (muscle tightening) or liposuction surgery.

Abdominoplasty involves removal of extra skin and tightening of the core muscles that are pulled apart by pregnancy (rectus plication). Liposuction is used to address stubborn pockets of fat that don’t respond to exercise and weight loss. Neither operation is a substitute for weight loss!


The effects of childbearing on your pelvis and vagina depend on a number of factors including type of delivery, size of babies, maternal age, genetics, and individual anatomy. A woman with a narrow pelvis and a 10 pound baby will have completely different long-term effects of her delivery compared to a woman with a wide pelvis and an average-sized baby. A woman with a C-section faces a different set of challenges in her recovery than a woman with vaginal deliveries. A few of the long-term effects that women face are:

  1. Vaginal laxity (looseness): more common after vaginal delivery
  2. Discomfort or pain with sexual intercourse
  3. Urinary leakage
  4. Pelvic heaviness
  5. Uterine prolapse
  6. Thick, itchy C-section scar
  7. Excess labia

Many of these effects can be treated with non-surgical therapy directed by your Ob/Gyn and a physical therapist who specializes in pelvic health. The first step is a careful physical examination and documentation of symptoms with your Ob/Gyn, followed by appropriate referral to the right place. Occasionally, women need surgical intervention for these symptoms if conservative management fails.