Pregnancy, Politics and Plastic Surgery

By John Newton

“Mummy Tuck” and “Tummy Tuck” – are these just cosmetic operations to get your figure back to the way it looked before children?

Well, yes, they may help with that, but for so many women, these operations do so much more. When a woman grows with pregnancy, the tendinous structure between the “six-pack” muscles stretch apart. Not only the six-pack muscles, but all the abdominal muscles are affected. In about two thirds of women, these muscles return to an adequate position, but in one third of mums they stay separated and even extensive physio and exercise do not restore their position and, importantly, their function amounting to a loss of core strength.

We hear about how important core strength is all the time. It is the strength in our abdominal muscles and our back. It is so important because it is the stable base from which all our other muscle function originates. Without it, we are very much weakened. The consequences are direct, in the form of back pain and urinary incontinence, with the flow-on problems of decreased physical activity, reduced quality of life, difficulty returning to work, personal hygiene problems, social inconvenience and a reduction in desire to become pregnant again for fear of worsening the situation.

A woman’s perception of what she can do may be dramatically altered. Sporting activity, working capacity, social interaction and sexual activity can all be compromised because of fear of pain and embarrassment. And why does this happen? Quite simply because a woman has a baby and becomes a mother. For many, one of the most wonderful things in their lives.

Can anything be done to correct the problem?

Absolutely yes! Repairing the muscle separation restores the integrity of the muscles and their function. Repairing the muscles is an integral part of Abdominoplasty (a.k.a. “Mummy Tuck” and “Tummy Tuck”). The majority of women who undergo repair report a significant improvement in core strength with reduced back pain and reduction of urinary incontinence. We know this from clinical trials performed initially here in Australia which have been reinforced by subsequent overseas trials.

So, what is the political point of this article?

Abdominoplasty for post-partum abdominal stretching was a Medicare rebatable operation until it was reclassified in 2016. As a consequence, it is only rebatable in cases of significant weight loss and not for problems occurring as a result of pregnancy. The reason was that, at the time, there was not enough evidence to support the operation as a reconstructive procedure.

Now there is a lot of clinical evidence supporting its important place in re- establishing normal function after pregnancy and therefore its reinstatement as a rebatable operation.

Furthermore, Kerrie Edwards, a mother of twins, has organised a petition of 13,000 signatures which has been submitted to the government.

This was presented, along with a clear description of the overall situation, to parliament by Dr. Fiona Martin, MP (and proud mother of four children) on 13 October 2020.

It was very favourably received. Health Minister Mr Greg Hunt, MP has promised to offer Medicare subsidies on abdominal surgery for women with birth injuries if an independent committee approves a new request from the Australian Society of Plastic Surgeons.

In my practice, I see a lot of women with muscle separation after having children. The operation is a major one and to call it a “Tummy Tuck” rather than an abdominoplasty is to trivialise it. It can, however, be a life-changing procedure. To have a young mother tell me that she can now play with her children is quite moving.

We place a lot of emphasis on perinatal care, but we have been ignoring this postnatal problem.

Dr. Fiona Martin pointed out that attention to this problem is important to women’s health, Australian families and women in the workforce.

Dr. Martin’s presentation can be viewed on her Facebook page and if you sympathise with the concept of this surgery being more readily available, feel free to write to your member of parliament.


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