Post Pregnancy Sagging Mons Pubis and Fatty Upper Pubic Area (FUPA)

FUPA (Fatty Upper Pubic Area), also known as bulging or sagging mons pubis, occurs when fat accumulates around the mons pubis due to pregnancy, abdominal surgery, or massive weight loss. The mons pubis is the region between the genitals and the pubic hairline, shaped like an upside-down triangle.

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After pregnancy or a major weight loss, many women may notice an accumulation of fat around the mons pubis, giving it an unpleasant bulging or sagging effect. Other factors that may result in loose skin or fat accumulation around the mons pubis include age, genetics, hormonal changes, or gain weight and abdominal surgery like a C-section.

Monsplasty is a surgical treatment designed to remove excess fat and loose skin around the mons pubis.

What is Mons Pubis Surgery (Monsplasty)

Monsplasty helps to remove the extra skin and extra tissue from a large mons pubis making it possible to wear tight pants again.

A monsplasty (pubic lift) is a cosmetic procedure that addresses the bulging/sagging pubic mound, getting rid of the stubborn fat in the upper pubic area. The procedure addresses the excess fat and skin by tightening, lifting, and reshaping the mons pubis. The mons pubis region is the triangular shaped pubic mound tissue from the genitals to the upper part of the pubic bone, usually covered with pubic hair.

Gaining weight will result in fat accumulation around the pubis, causing it to bulge outwards. This will result in the skin around the region stretching to accommodate the extra fat. If the weight gain happens for a short period, the skin is able to stretch and retract to its original size.

However, if the weight gains last for longer periods, the skin’s elasticity wears off. Therefore, sudden loss of significant amounts of weight leaves the pubis with loose, sagging skin. This results in a sagging mons pubis, which is hard to get rid of with exercise or a healthy diet.

Other factors that would result in a fatty upper pubic area include:

Age: The skin is made of collagen fibres and other interconnective tissues that affect its elasticity. The body produces collagen in low quantities with age. Therefore, the skin loses its elasticity and becomes thin, resulting in sagging skin.
Abdominal surgery (C-Section): After childbirth through a C-section, the skin around the scar remains tight. However, the skin below the scar doesn’t, and it may result in a budge in the pubis.
Genetics: Some patients are predisposed to fat deposition in the mons pubis. This means that if a family member had the complication, the patient too might get it.
Hormones: An increase in levels of hormones like estrogen can cause an increase in fat deposition in the mons pubis.

In addition to improving the mons pubis contour, monsplasty also improves the functionality of the region. Sagging mons pubis can cause reduced hygiene, infections, rashes, urination and sexual difficulties. Further, by removing this unwanted fat, monsplasty can restore self confidence, improve sexual intimacy, and make it possible to wear a bathing suit once again.

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What is involved in a Mons Pubis (Monsplasty) surgery?

Monsplasty involves the removal of excess mons pubis skin and fat. Patients with excess fatty tissue will undergo liposuction procedures to remove the fatty tissue, while those with excess sagging skin will undergo skin excision.

Before the procedure, the surgeon will make marks on the excision region. The marks act as guidelines to ensure symmetry. The next step involves anesthesia administration. The procedure takes approximately one hour, but that can be longer when liposuction is involved. It can be done has a day procedure.

Liposuction

Liposuction is carried out as the first procedure. Pubis liposuction removes excess fat but liposuction doesn’t address excess skin. Therefore, patients with sagging skin resulting from weight loss or age will require skin excision.

Skin Excision

Skin excision is suitable for patients who have developed excess loose mons pubis skin. The surgeon makes a horizontal incision on your lower abdomen, usually, the location of an abdominoplasty’s incision. After making the incision, the surgeon removes the excess skin and places the incision such that the underwear hides it.

Mons Lift

After removing the excess skin, the surgeon tightens the tissues underlying the pubic bone. The surgeon also pulls and tightens the muscle using sutures, resulting in a mons pubis lift. The incision is then closed with surgical adhesive or absorbable sutures. This process not only boosts one’s aesthetic, but also improves stress urinary incontinence. A scientific study published in National Library of Medicine concludes “A combination of complete abdominoplasty with Mons full pubic lift can be offered to improve SUI in people who are interested in body shaping.”

Fat Transfer

On some occasions, fat grafting can be conducted on the mons pubis. The procedure is recommended for patients with atrophy. The surgeon harvests fat cells through liposuction from other body parts like the thighs and injects it into the mons pubis.

Combination Procedures

Monsplasty may be carried out in combination with other procedures like abdominoplasty. This is due to the proximity of the mons pubis and the lower abdomen. This ensures the surgeon uses the same incision for both procedures. In addition, a bulging mons pubis is often noticeable after the removal of excess skin and fat in the lower abdomen, therefore necessitating a monsplasty.

A study on monsplasty states that “It can be incorporated in both esthetic and reconstructive abdominoplasties and should be a standard component of the procedure for cases with mons ptosis grade 2 or higher.”

Preparing for Mons Pubis Surgery

Preparing for a monplasty involves the following process:

Initial Consultation with a Surgeon

The patient books a consultation with a specialist surgeon where they discuss their needs and expectations. This allows the surgeon to understand the patient’s goals in order to customise the procedure.

The surgeon also discusses the expected surgical risks and helps the patient manage their expectations. At this stage, the patient can book for a second consultation or proceed to choose the surgery date.

Medical Evaluation

The surgeon does an initial evaluation of the patient’s health. This involves a careful medical examination to assess the suitability of the procedure. The surgeon considers the patient’s overall health, age, expectations, emotional well-being, weight, and medical history.

The patient should disclose their medical history and any medication they are taking to ensure the surgeon prepares adequately for all the possible surgical risks. During the evaluation, the surgeon also examines the mons pubis to assess the amount of excess skin and fat and may also take photographs for medical records.

Follow Pre-Operative Instructions

After the medical evaluation, the surgeon gives the patient a list of pre-operative instructions to follow. These include quitting medication such as anti-inflammatory drugs and aspirin to reduce the risk of excessive bleeding. The patient is also required to quit alcohol at least two weeks before and after the procedure.

Stop Smoking

The patient should stop smoking at least 6 weeks before and after surgery to minimise complications. The surgeon may suggest a longer period, depending on the patient’s smoking history. A literature review of PubMed states, “Smoking is an independent risk factor for wound healing complications, but not for free flap loss. Smokers who are candidates for plastic surgery should cease smoking for an adequate amount of time preoperatively.”

Download our short guide: “Preparing for your Tummy Tuck Surgery Checklist”

Arrange for Support After Monsplasty Procedure

After surgery, the patient will require support getting home and doing their daily chores. This should be arranged before surgery.

Prepare Your Recovery Space

The patient will require bed rest for a couple of days. Therefore, they should prepare their recovery space adequately, ensuring they have all the essentials to make the period as comfortable as possible.

Arrange for Time Off from Work

It takes two to three weeks for most patients to resume light chores. Therefore, the patient should arrange for time off work during this period.

Follow Fasting Guidelines

An article on pre-operative fasting notes that “Preoperative fasting is necessary to reduce the risk of regurgitation of gastric contents and pulmonary aspiration.”

Most medical practitioners recommend that patients should avoid meals for at least six hours before surgery. Clear liquids like water and coffee are allowed up to two hours before surgery. However, your anaesthetist and the hospital that you go to will advise you directly about what they recommend. This can vary.

Emotional Preparation

Emotional preparation is equally important as physical preparation. It ensures the patient is well prepared for the surgery and has realistic expectations.

Recovery From Mons Pubis

Recovering from mons pubis takes some time. Below is the expected full recovery time timeline.

Immediate Postoperative Period

Immediately after surgery, the incision is dressed with bandages and a compression garment. The patient will experience pain after the anesthesia effects wear off. The anaesthetist prescribes painkillers to ease the pain. Dr. Bernard Beldholm MBBS B.Sc (Meod), FRACS founder and CEO of Body Contouring Surgery Clinic Pty Ltd recommends the patient stay overnight at the hospital for monitoring.

First Week

The patient experiences discomfort and pain and will have trouble moving around. However, they are encouraged to take light walks around the home after two days to encourage blood circulation which boosts healing. The pain and discomfort subside gradually.

Follow-Up Appointments

Follow-up appointments ensure the surgeon monitors the recovery. During these appointments, the surgeon will also check for any wound infections and abnormalities.

Swelling and Bruising

Bruising and swelling are normal after surgery. These will be intense in the first week but subside by the second to third week. However, residual swelling takes longer.

Physical Activity

Most patients can resume work two to three weeks after surgery. However, intense physical activity is discouraged until around four to six weeks.

Scar Management

Scar management is important during recovery to prevent scar infection and bad scarring. This may involve cleaning the incision, applying scar treatments, and massaging the incision site.

Long-Term Results

The results of a monsplasty will be visible after three-six months. However, the final results may take twelve months or more as residual swelling subsides completely. Please note that results may vary among patients.

What Will the Scar Look Like After Mons Pubis Surgery?

Most patients, specifically those highly concerned with aesthetics, are worried about their post-surgery scars. There are a few factors that will determine how your scar will look like.

Placement of Incision

A monsplasty incision is placed horizontally along the lower abdomen, similar to an abdominoplasty (tummy tuck) incision. An abdominoplasty (tummy tuck) incision is used in cases where the patient has previously undergone an abdominoplasty.

Suture Technique

The surgeon uses absorbable sutures to tighten the underlying mons pubis muscles and then closes the incision with absorbable sutures or surgical glue.

Scar Care

Scar care involves scar treatments to reduce scarring. Massaging the incision site also helps to enhance healing and reduce scarring.

Individual Healing

It’s worth noting that different patients heal differently due to individual factors like age, overall health, and invasiveness of the procedure.

Is Mons Pubis Surgery Painful?

Just like other surgical and cosmetic procedures however, discomfort and pain are common side effects after a monsplasty however, your surgeon will likely prescribe pain medication to manage the pain.

Risks and Complications of Mons Pubis Surgery

There are risks associated with this surgery and it’s prudent for patients to be familiar with them so that they can be well-prepared. Some of the common ones include.

Infection and poor wound healing
Excessive bleeding
Bad scarring
Nerve damage
Asymmetry of the mons pubis
Allergic reactions to the anesthesia
Unsatisfactory results
Seroma and hematoma

Pregnancy Following Mons Pubis Surgery

It’s not advisable to get pregnant after a monsplasty. However, getting pregnant may not affect the results of the procedure.

Sexual Intimacy Following Mons Pubis Surgery

Patients should follow their surgeon’s advice and allow adequate wound healing. In addition, patients are advised to start slowly and ease into it. It’s important to communicate with your partner and find what is suitable for you.

Most surgeons recommend that patients avoid sexual intercourse for at least 4 weeks after surgery.

Benefits of Mons Pubis Surgery

Understanding the potential benefits of mons pubis surgery provides individuals with valuable insight into how the procedure can positively impact their lives. These include:

Improving the mons pubis contour
Reducing chronic infections resulting from excess skin around the mons pubis area
Improving sexual life
Reducing difficulty in urination
Improved hygiene of the genitals

A study on monsplasty effectiveness reports “A significant improvement in body image (p < 0.001), satisfaction with the abdomen (p < 0.001), and sexual functioning (p = 0.009). Functionally, improvements were recorded with regard to visualisation of the genitalia (36%), hygiene maintenance of the pubic area (32%), sex life (48%), genital sensitivity (24%), and urinary continence (4%). Patient satisfaction was very high.”

Cost of Mons Pubis Surgery in Australia

Monsplasty costs approximately $3,000-$8,000, with an average cost of $5,000. Medicare rarely covers the cost of a monsplasty because it’s considered a cosmetic procedure.

Conclusion

Eliminating sagging skin and excess fat around the mons pubis can be challenging through a healthy diet and exercise alone. Monsplasty is an effective surgical procedure that addresses FUPA (Fatty Upper Public Area) and post-pregnancy sagging of the mons pubis.