​I often hear from women who want to know how best to rejuvenate their bodies and get back to feeling as strong and vibrant as they did before they had children. Many of my patients are wondering if now is a good time for the so-called “mommy makeover,” a concept that has gotten lots of buzz in recent years. Most of these women are not looking for a “makeover,” however; they are simply looking to turn the clock back a little bit on the bodies that they already have.
 
In order to decide if this set of restorative surgeries could be a good fit for you, here are answers to some of the questions I’m asked most commonly by my potential patients. 
 
What is the “mommy makeover”?
There isn’t one specific set of surgeries that are always performed as part of a mommy makeover. Rather, it is typically some combination of operations, done in sequence, which focus on improving the appearance of a woman’s abdomen and breasts—the two areas of the body that bear the brunt of the “damage” from pregnancy, postpartum recoveryand breastfeeding. 
 
Common surgeries in a mommy makeover include the following:

• Abdominoplasty: Also known as a “tummy tuck,” this is done to remove excess skin, typically of the lower abdomen, as well as repair the rectus (or “six-pack”) muscles that often separate during pregnancy. Abdominoplasty helps to make the abdomen appear flatter and firmer.
• Breast surgery: To combat the breast deflation or “drooping” (ptosis) that is a normal part of the body’s post-pregnancy progression, many women seek restorative breast surgery, including breast implants (ideal for women experiencing mild breast sagging or desiring more volume) or a mastopexy (commonly known as a breast lift) to improve the appearance of the breasts. Some patients need a combination of both a breast lift and an implant.
• Liposuction: This surgery removes fat from specific areas of the body including the abdomen, hips, thighs, buttocks, arms, or neck. 

 
Am I an ideal candidate for a mommy makeover?
Most of my patients come in with an idea of what areas they would like to target for improvement. However, not every mom is an ideal candidate for these procedures. Abdominal surgeries, breast surgeries, and liposuction are best for women who:

• Are in generally good health and close to their ideal pre-baby weight. It’s important to understand that these are not weight-loss surgeries; if you are still working toward losing significant weight, it’s probably not yet the right time for a mommy makeover.
• Are not planning any future pregnancies. You don’t want to invest the time and money into surgeries if you are planning to have more children.
• Will not be picking up and carrying young children around frequently. I recommend my patients wait until their youngest child is at least 18 months old before having surgery. This way the child is old enough where Mom will be able to recover from surgery more easily and not have to worry about lifting them during the first few weeks post-op.
• (For breast surgeries) Have finished breastfeeding for at least one year. This is a rule in my practice. Your milk ducts still retain a lot of fluid for a long time and that can complicate a breast surgery.
• No nicotine use, as this adversely affects healing.

 
What should I expect for surgery and recovery?
Of all the common mommy makeover procedures, the abdominoplasty requires the most significant downtime. You’ll need about 4-6 weeks to heal. However, you will be able to go home the night of surgery and you will soon be up and able to move around without much difficulty. You’ll need to wear post-operative compression garments and you’ll have some drains to take care of for a week or so, but you’re definitely not incapacitated. Breast-surgery patients can expect an easier recovery. My breast patients probably take two weeks off from work after their surgery, but during the recovery time they are home with their families and living their daily life without too much disruption.
 
Are the surgeries done on a specific timeline?
With some very select patients, you can combine the procedures and do them at the same time, but my preference is to do the abdominal and breast surgeries in two different operations, separated by a minimum of six months. 
 
What are the risks?
As with any surgery, the mommy makeover procedures carry certain risks, including: 

• Infection
• Fluid build-up 
• Risk of blood clots, including DVTs and pulmonary embolisms. This risk is slightly higher with abdominoplasty than with other plastic surgeries, so we try to mitigate by giving patients medications that prevent blood clots. 
• Breast surgery can affect your future ability to breastfeed and your nipple sensitivity

 
The best risk prevention is making sure that you’re always seen by a Board Certified Plastic and Reconstructive Surgeon who operates in an accredited facility with licensed anesthesiologists. 
​

Written by Dr. Alessandrina Freitas who sees patients in White Plains at the Center for Advanced Medicine & Surgery as well as at WPH Medical & Wellness in Armonk. To make an appointment, call (914) 683-1400 or click here.

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​Figuring out when to introduce babies and children to foods that have a high potential of causing an allergic reaction can be one of the trickiest questions to consider as a parent. To help soothe parents’ anxiety and ensure they are giving their children the proper introduction to these foods, I work closely with families to update them on the latest food-allergy guidelines. Here are some tips that will help you confidently introduce these foods to your kids. 
 
What foods are the most likely to cause potential allergies?
The major food allergens include milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish, and sesame. The most common food allergens for children are peanut and milk, with cow's milk the most common food allergen in early life.
 
What is the right approach for early introduction of these potential food allergens?
Fearing adverse reactions, many parents historically preferred to wait before introducing these potential food allergens to their kids. But that’s no longer the prevailing wisdom among experts. Doctors no longer believe that waiting until baby is older prevents food allergy. In fact, there is evidence that introduction to peanut in the first year of life can prevent the development of peanut allergy. Especially in infants who are at high risk of developing food allergy, the emphasis is now on early introduction of peanut and egg, rather than avoidance. 
 
Typically, in babies without eczema or any food allergy, I recommend introducing age-appropriate allergenic foods in the first year of life in accordance with family preferences and cultural practices. I suggest prioritizing the introduction of peanut and egg, which has demonstrated evidence of benefit. There are currently no specific guidelines on order of egg and peanut introduction but it should be a shared decision made between parents and the baby’s doctor. 
 
For babies with mild to moderate eczema, we recommend introducing peanut-containing foods at around 6 months of age. If your baby has severe eczema, you are concerned that he/she has an egg allergy and you have not yet introduced peanut, I recommend seeing an allergist as early as 4 to 6 months of age to determine if peanut should be introduced and, if so, the preferred method of introduction. If your baby has severe eczema and/or egg allergy, and you had already introduced peanut which he/she tolerates without any problem, please continue feeding your baby peanut to reduce the risk of peanut allergy once you start avoidance. 
 
What is the best way to introduce these foods?
Once your baby has successfully eaten other solid foods (like single-grain cereals, followed by fruits, vegetables), you can begin to introduce allergenic foods in age-appropriate forms. That doesn’t mean Eggs Benedict or a PBJ sandwich, of course! Follow these tips for easy introduction of these tricky foods:

• Start with a small amount: just a spoonful or two of any allergenic food is enough to give baby a taste of the flavor and watch for potential allergic reaction.
• For peanut, the National Institute of Allergy and Infectious Diseases (NIAID) recommends infant-safe forms in the amount of 2 teaspoons, 3 times per week (for a total of 6 grams of peanut protein). 
• To prevent choking in infants, try thinning peanut butter with water, milk, or pureed fruit. This dilution may be necessary until children are able to safely eat foods with the consistency of peanut butter spread thin—that can be after 12 months of age or based on individual developmental abilities.
• During the initial feeding period, serving single-ingredient foods, one at a time, is recommended to observe for symptoms of allergy. Once foods are tolerated, they can be combined.
• There is no evidence guiding how long a given food must be fed before moving on to the next new food. However, generally, when offering a potential food allergen, I advise parents to give baby an age-appropriate serving size at least 3 times over 3-5 days to confirm tolerance.
  
  

What are the different types of allergic reactions in infants and toddlers—and how serious are they?
Recognizing allergic reactions in infants and toddlers can be challenging for not only parents and caregivers, but also providers, as your baby is unable to verbalize what they are feeling/experiencing when they are having an adverse food reaction. Behavior changes that may be noted during a reaction can include clinginess, fussiness, or inconsolability, but it is important to note that these behaviors alone may also be present in healthy infants not experiencing an allergic reaction. 
 
Skin, gastrointestinal, and respiratory symptoms were most frequently reported in infants and toddlers, although symptoms involving other organ systems can also occur. 

• The type of skin reaction may be “itching, rash, hives or swelling.” Please note the location of the skin reaction with respect to where the skin had contact with the allergen so we can determine if the reaction was the result of a topical contact reaction or a systemic reaction, the latter of which is more concerning. Please take pictures as they are worth a thousand words when you seek consultation with an allergist.
• The most common gastrointestinal symptom is vomiting, although diarrhea can also be considered a potential allergic symptom. 
• Belly breathing, fast breathing, nasal flaring, chest or neck “tugging,” wheezing, hoarse voice, hoarse cry, and repetitive cough are all examples of respiratory symptoms.

 
Timing of the adverse reaction relative to when your baby consumed a potential culprit food is extremely essential, as there are different types of food-induced reactions including scenarios where administration of epinephrine, the first-line treatment of anaphylaxis (a severe life-threatening allergic reaction) is indicated. Diagnostic testing and management can be very different for each type of food-induced reactions; for example, skin testing and an epinephrine auto-injector prescription likely are not appropriate for food intolerances,and concerns that certain foods may exacerbate underlying eczema would warrant a separate discussion. I recommend keeping a food diary when you start to notice these reactions in your baby, particularly if they become recurrent so that you and your allergist can have a full conversation about how to proceed. 

While introducing baby to allergenic foods can be a stressful experience, it is so important for their growth and development! The goals of early infant feeding are to introduce foods of varying flavors and textures to encourage future food preference, and to provide nutrition in a balanced and proportional manner for growth and development. Increasing the diversity of both food and food allergen intake in the first year of life is associated with a lower prevalence of food allergy—something all parents are hoping for.

Written by ​By Dr. Angela Chan, Board-Certified Pediatrician and Allergist-Immunologist, Scarsdale Medical Group in Harrison. Click to learn more or call 914-723-8100.

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