Dr Enrico Pöschmann, renowned for his extensive expertise in modern hernia surgery, is the Medical Director of the Swiss Hernia Center, where he and his team cover the entire spectrum of the speciality. His many years of experience make him a highly regarded specialist in the treatment of complex hernias, incisional hernias, rectus diastasis, and sports hernias. With the aid of excellent diagnostics and innovative surgical techniques, Dr Pöschmann offers his patients tailor-made treatments.
The Swiss Hernia Center has quickly established itself as a top-class center of excellence and now has locations in the cantons of Zurich, Schaffhausen, Schwyz and Zug. It functions as a recognized center of excellence and works closely with various hospitals and medical practices. Dr Pöschmann’s areas of specialization include surgery for all types of abdominal wall and diaphragmatic hernias, including complex revision procedures and corrective operations, which are predominantly performed using minimally invasive or robot-assisted techniques. He also treats severe abdominal adhesions and intestinal obstructions, as well as malignant tumors and metastases in the abdominal cavity using minimally invasive techniques.
His high level of expertise is based on many years of academic and clinical training, including a degree from the renowned University of Leipzig and a teaching post at the University of Zurich. Under the leadership of Dr Pöschmann, the Swiss Hernia Center offers its patients state-of-the-art diagnostic facilities and a wide range of surgical options. Patients benefit not only from excellent medical care, but also from the pleasant atmosphere and the center’s excellent location.
Women in particular who need to have an abdominal wall hernia or rectus diastasis corrected following childbirth or multiple pregnancies are in good hands with Dr Pöschmann. Together with his team, he combines their treatment in a single operation with plastic or aesthetic procedures, such as a tummy tuck, liposuction or a breast lift. The editorial team at Leading Medicine Guide had an interesting conversation with Dr Pöschmann about the ‘mummy makeover’ trend, which originated in the USA.
A “mummy makeover” is a comprehensive concept in plastic surgery specifically tailored to the needs of women whose bodies have been altered by pregnancy and childbirth. The process of pregnancy, childbirth and breastfeeding can leave significant marks, including rectus diastasis (separation of the abdominal muscles), excess skin on the abdomen and sagging or deflated breasts. These physical changes can affect a woman’s self-confidence and well-being. A Mommy Makeover offers the opportunity to correct these changes through a combination of targeted surgical procedures. The approach to a Mommy Makeover is personalized and tailored to the patient’s specific needs and wishes. The goals and suitable procedures are discussed during a detailed consultation.
After pregnancy and childbirth, many women struggle with physical changes. A Mummy Makeover can effectively correct these.
“The changes that become apparent after pregnancy and childbirth result from a combination of hormonal changes, weight gain and loss, and alterations to the abdominal wall and mammary glands. A typical example is what is known as rectus diastasis. During pregnancy, the abdominal muscles stretch to make room for the growing baby. This can cause the rectus abdominis muscles to separate, a condition known as rectus diastasis. This change can lead to a permanently protruding abdomen, even after childbirth. This is often accompanied by stretch marks in the abdominal area, fat deposits in the thighs, varicose veins on one side and sagging breasts. This is not acceptable to every woman. However, some mothers only come to see me a few years after giving birth and request a ‘mummy makeover’, as fashion and lifestyle activities become more relevant again. However, I also have many young patients who come to me once they have finished having children. The ‘mummy makeover’ is common in the USA, but this procedure is also being performed more and more frequently in Switzerland and Germany. “People are simply much more active, and ultimately it’s about mental well-being, which goes hand in hand with a healthy and satisfying body image and a look that suits you,” explains Dr Pöschmann at the start of our conversation.
Many women find that after pregnancy, fat deposits in certain areas of the body are difficult to reduce through diet and exercise alone. Typical problem areas are the abdomen, hips, thighs and back. Childbirth, particularly vaginal birth, can lead to changes in the genital area, such as sagging tissue, which can be corrected through plastic surgery. Body proportions often change after pregnancy. Some women wish to have their harmonious body contours restored. A ‘mummy makeover’ can consist of various surgical procedures, individually tailored to the woman’s needs, to address these changes. Typical procedures include a tummy tuck, a breast lift or augmentation, liposuction and sometimes a vaginal tightening procedure. The aim is to restore the body to a condition similar to that before pregnancy and to boost the woman’s self-confidence.
Rectus diastasis often plays a significant role when a woman decides to have a mommy makeover, as for many it represents a distressing change to the body following pregnancy.
“First, there is a detailed examination – including an ultrasound scan. The extent of the rectus diastasis is measured. In the first year after childbirth, we only operate on rectus diastasis if there are also incarcerated hernias present. It is important to clarify what symptoms are currently present. Is it purely a cosmetic issue, or are there health problems due to instability, back pain, hernias in the diastasis, difficulty with bowel movements or pelvic floor weakness? It is important to know whether the patient has finished having children or not. All of this is considered holistically and discussed. If there are further requests, such as corrections to the breast area, thighs or buttocks, these can be incorporated into the treatment,” says Dr Pöschmann.
The treatment of rectus diastasis as part of a ‘mummy makeover’ aims to bring the muscles back together and tighten the abdominal wall. This is usually achieved through an abdominoplasty (tummy tuck), in which excess skin is removed and the muscles are surgically repaired. This procedure can offer both aesthetic and functional benefits by flattening the abdomen and restoring the stability and function of the core. A ‘mummy makeover’ that addresses rectus diastasis can therefore not only improve a patient’s appearance but also significantly enhance her quality of life.
“There are two options for the surgical treatment of rectus diastasis. Option 1 is a minimally invasive procedure in which a permanent or absorbable mesh is inserted, or the abdominal muscles are reattached to their original position using sutures. For this option, a camera and surgical instruments are inserted through three small incisions in the lower abdomen. Option 2 involves open surgery, combining the correction of rectus diastasis with a tummy tuck. For this, a section of the abdominal skin is removed up to the navel area, allowing excess skin and fatty tissue to be reduced. The post-operative care is the same for both options. The patient remains in hospital for approximately 5–7 days following the procedure, followed by a 6-week recovery period. If the ultrasound shows a good result, physiotherapy and muscle strengthening can begin. The immediate discomfort following the operation is slightly greater with the open procedure than with the minimally invasive one,” according to Dr Pöschmann.
A mommy makeover combines several surgical procedures and, like any operation, carries certain risks.
“Depending on what is involved in the mommy makeover, there are different risks. A major concern is certainly the risk of infection, or wound healing complications and skin necrosis. In any case, the procedure must be carried out with the shortest possible operating times and by a well-coordinated team to ensure a satisfactory result,” comments Dr Pöschmann.
To keep the risks to a minimum, comprehensive pre-operative examinations are carried out. Choosing an experienced and qualified plastic surgeon is crucial to reducing the likelihood of complications. During the operation, the procedure must be carried out under completely sterile conditions to prevent infections. Modern anesthetic techniques minimize risks associated with anesthesia. Careful post-operative monitoring and care enable complications to be detected early and treated immediately. Dr Pöschmann emphasises: “Risks can never be completely ruled out, but they can be minimized through minimally invasive techniques, particularly with regard to infections and bleeding.”
At the Certified Swiss Hernia Center, around 100 ‘mummy makeover’ operations are performed each year.
After the operation, it is important to take sufficient rest and follow the treating surgeon’s instructions precisely. This includes observing rest periods and avoiding strenuous physical activity for an agreed period of time. Wearing compression garments can help reduce swelling and promote tissue healing. A healthy diet and adequate fluid intake are also important to provide the body with optimal support during the recovery phase. This helps to boost the metabolism and speed up wound healing. Regular follow-up appointments with the surgeon are necessary to monitor the progress of healing and identify any potential complications at an early stage. Adherence to post-operative care instructions, such as proper wound care and taking medication, is crucial for a successful healing process. Furthermore, patients should be patient, as the final results of the mommy makeover often only become visible after a few months, once the swelling has subsided and the scars have faded. Emotional support from family and friends is also helpful during the recovery period.
A non-surgical treatment option, such as a tummy tuck using non-invasive procedures, can be an attractive alternative to a surgical mummy makeover, particularly in certain situations.
“Among the minor, invasive options are injections of collagen or Botox to reduce wrinkles and support skin tightening. These are combined with other cosmetic treatments such as massages or lymphatic drainage. However, if one does not wish to penetrate the skin’s surface, fat cells can be frozen away using cold, or the layer of fat beneath the skin can be targeted using plasma pens or specialized light therapy,” says Dr Pöschmann regarding non-surgical measures. The decision to opt for a non-surgical option may also be based on personal preference, particularly if a patient prefers a less invasive solution or is not suitable for surgical intervention for health reasons.
Robot-assisted procedures, such as those performed using the DaVinci system, have become increasingly important in hernia surgery. Compared to conventional, open or minimally invasive techniques, robot-assisted procedures offer a number of specific advantages and differences.
The DaVinci system enables surgeons to perform more precise movements and obtain a better view of the surgical field. This is achieved through the use of small instruments inserted via small incisions (so-called keyhole or minimally invasive techniques). These instruments are controlled by robots that can delicately translate and refine the surgeon’s hand movements. This allows operations to be performed with greater precision, particularly in tight or hard-to-reach areas, such as when treating complex hernias. Another advantage of the DaVinci system is the improved view provided by the high-resolution camera, which offers a three-dimensional view of the surgical field.
“When it comes to abdominal wall reconstruction using minimally invasive techniques, we very often use the robot because it allows us to operate with low risk, particularly in very slim patients where space within the abdominal wall is very limited, achieving good stabilization and minimizing post-operative pain. We do not use the robot for other operations (lifts, breast replacements). However, minimally invasive surgery is also gaining ground here, with ever-thinner cannulas for inserting breast implants and very small incisions in the armpit. Both approaches – the use of the robot and minimally invasive surgery – are designed to ensure that the strain on the body is kept to a minimum and that rapid healing can be achieved,” says Dr Pöschmann regarding the use of the robot.
The return to the original body shape after childbirth varies greatly among women.
While some women get back into shape quickly, others struggle for a long time with excess weight and changes to their bodies. These differences can be attributed to several factors. Genetics and the composition of connective tissue play a significant role, as they influence how the body reacts to pregnancy and childbirth. In addition, physical activity and dietary habits before and after pregnancy have a significant influence on the body’s recovery.
Dr Pöschmann explains: “If someone is already in good physical condition before pregnancy, takes good care of themselves – including their skin – exercises regularly and is blessed with strong muscles, they naturally have a better starting point when it comes to pregnancy. However, this is no guarantee, as there are also genetic factors and variations in how a pregnancy develops that cannot be influenced at all. For example, if you have weak connective tissue, you are also prone to varicose veins. Weak connective tissue also affects the severity of rectus diastasis or the sagging of breast tissue. Even young, physically active women can find that everything sags after pregnancy. They too can gain 20 kilos or retain water. There are women who don’t look like they’ve given birth to four children, while others develop significant visual changes after the birth of their first child because their bodies have suffered massively.”
And who pays for all this?
“If there is severe abdominal wall instability caused by a large rectus diastasis, which leads to severe back pain, weakens the pelvic floor and causes incontinence, and there are even abdominal wall hernias present, we would advise having this treated surgically as a medical procedure. This is covered by health insurance if the application is approved in advance. Cosmetic procedures such as additional liposuction, breast augmentation or thigh lifts must be paid for by the patient herself. A ‘mummy makeover’ offers several procedures in a single operation, based on a modular approach, to reduce costs and downtime for the patient. A team of consultants and specialists looks after the patient and discusses with her exactly what is to be done and which cosmetic corrections might be covered by private health insurance due to medical indications. For example, if there are changes to the breasts following pregnancy that could lead to fibrosis (scarring). This is discussed in advance with the treating gynecologist,” explains Dr Pöschmann.
Tips for expectant mothers
“Maintaining muscle tone with exercises for the abdomen and back is important during pregnancy. Good skincare with appropriate moisturising to keep the skin supple is essential so that it can stretch gently. Together with the midwife and the attending gynecologist, a nutrition plan is drawn up to ensure a balanced diet, manage weight and strengthen connective tissue. This way, you can certainly make your own personal contribution to maintaining the body’s structures as well as possible. Unfortunately, there is not much that can be done about genetic predispositions,” explains Dr Pöschmann, adding with regard to the Swiss Hernia Center:
“In cases of severe rectus diastasis, we always recommend a supportive mesh implant behind the muscles to ensure long-term stability, rather than relying solely on sutures. We are increasingly using biodegradable plastic meshes that dissolve over time. This ensures lasting stability and elasticity. The risk of recurrence can also be significantly reduced in this way. In our center, this stands at under 1% in otherwise healthy people.” We conclude our conversation on this positive note.
Thank you very much, Dr Pöschmann, for your detailed and informative explanation!
