Pregnancy can cause remarkable changes in the body. However, postpartum changes like a sagging mons pubis or Fatty Upper Pubic Area (FUPA) can greatly impact a new mum’s comfort and body contour. Shaped like an upside-down triangle, the mons pubis is the area between the genitals and the pubic hairline. Bulging or sagging mons pubis, AKA FUPA, occurs when fatty tissue accumulates around the mons pubis during pregnancy or after you lose weight.
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There are several factors that can contribute to pubic fat accumulation and loose skin around the mons pubis, including:
- Age – The skin is made of collagen fibres and connective tissues that affect its elasticity. With age, the body begins to produce less collagen, causing the skin to lose its elasticity and become thin, resulting in sagging skin.
- Abdominal surgery (C-Section) – After a C-section, the skin around the scar remains tight while the skin below it does not. This may result in a saggy pubis.
- Genetics – Some people are naturally predisposed to fat deposition in the mons pubis. If a family member has experienced this complication, there is a greater likelihood that the patient will as well.
- Hormones – An increase in oestrogen levels can cause fat deposition in the mons pubis area.
What is FUPA?
The primary function of the mons pubis is to protect and cushion the pubic bone. To accommodate a growing foetus during pregnancy, the body produces hormones that cause expectant mothers to gain weight in this area. FUPA (Fatty Upper Pubic Area) is the accumulation of fat cells around the mons pubis. Because the weight accumulated in the delicate region may be challenging to shed, I perform Monsplasty in conjunction with procedures like abdominoplasty (tummy tuck) and liposuction in many post-pregnancy mums to restore contour, reduce saggy skin, and increase firmness in the pubic region and surrounding areas.
What is Monsplasty?
A Pubic Lift, or Monsplasty, is a surgical procedure that addresses the bulging and sagging pubic area by removing excess fat and skin. A procedure involving liposuction and skin excision, and lifts the mons area.
Monsplasty is often viewed as a cosmetic procedure, but it also enhances the functionality of the area. A drooping mons pubis can lead to hygiene issues, infections, rashes, and difficulties with urination and sexual activity. By eliminating excess fat, Monsplasty can address these concerns, improve sexual intimacy, and allow for comfortable swimsuit wear.
According to a study by NCBI, “[m]onsplasty is a simple and fast procedure that can truly add value to the patient’s satisfaction and functional outcomes. It can be incorporated in aesthetic and reconstructive abdominoplasties and should be a standard procedure component for cases with mons ptosis grade 2 or higher.”
Preparing for Monsplasty Surgery
Before scheduling the procedure, it’s important for patients to be fully prepared. Below are some steps to take before undergoing Monsplasty surgery.
- Stop Smoking – Because nicotine constricts blood vessels, reducing blood flow to your tissues and the amount of oxygen the blood carries, I urge my patients to quit smoking at least six weeks before and refrain from smoking for six weeks after surgery to promote a speedy recovery and reduce the risk of complications.
- Arrange for Support After the Procedure – As it may be challenging to perform basic house chores after surgery, arrange for support before undergoing the procedure. I encourage you to have someone on standby to help with basic needs such as cooking, cleaning, transport, and personal care until you recover.
- Prepare Your Recovery Space – I will recommend a few days of bed rest, with guidelines on how to lay down comfortably to avoid straining your mons pubis. Prepare your space before surgery, making sure all the materials required are within your reach, including some extra pillows to help elevate your legs to reduce swelling and essential supplies such as water, snacks, medication, and personal hygiene products.
- Arrange Time Off from Work – Take some time off after work to avoid strenuous activities or sudden movements that can derail your healing progress. Most patients return to work 2 to 3 weeks after surgery, depending on their healing progress. I advise patients to always check in with me before returning to work for an evaluation, especially if their job involves physical demands.
- Follow Fasting Guidelines – Fasting before your surgery is essential as it lowers the risk of aspiration, where food contents are inhaled into the lungs during anaesthesia.
According to a recent study conducted by the NLM (National Library of Medicine), fasting times range from 7.5–17 hours, with an average of 13 hours and 5.1 hours for fluid (REF 11) proved most effective.
I will provide a fasting guide tailored for you. According to a study by ScienceDirect, “[g]astric emptying of clear liquids is rapid, exponential, and proportional to the current filing state of the stomach. Furthermore, there was no evidence of a link between drinking clear liquids and the risk of aspiration.”
Preparing for Initial Consultation
The first step in your mons pubis surgery is the consultation, during which we will discuss your expectations and goals as well as the available surgical options and the risks involved so you can make an informed decision.
- Medical Evaluation – I will consider your age, emotional well-being, overall health, medical history, and weight to determine the most suitable procedure for you. During the medical evaluation, you should disclose any past surgeries, current medications, and previous allergic reactions to help me prepare adequately for the surgery and avoid possible risks.
- Pre-Operative Instructions – After the evaluation, I will give you guidelines to follow before your surgery. I advise my patients to quit smoking for 6 weeks pre/post-surgery and stop taking medicines like aspirin and blood thinners to prevent excessive bleeding during surgery.
What is Involved in a Mons Pubis (Monsplasty) Surgery?
During Monsplasty surgery, I will remove excess skin from your pubic mound, tighten the underlying muscles and tissues, and perform the following procedures to ensure optimal results:
- Liposuction – I use VASER liposuction to break down and remove the stubborn fat cells from the FUPA. Liposuction helps to contour and reshape the mons pubis while giving me precision during skin excision.
- Skin Excision – I will then make an incision on your lower abdomen, where you can easily hide it with your inner wear, and remove excess fat and sagging skin. I recommend skin excision to patients with excessive sagging skin on their mons pubis.
- Mons Lift – After skin excision, I will tighten tissues and loose abdominal muscles surrounding the pubic bone using absorbable sutures that do not need to be removed. This process ensures that your aesthetic results are satisfactory.
- Fat Transfer – If you have mons pubis atrophy, I will perform fat grafting by taking fat cells from your thighs and using them to restore volume and contour your mons pubis.
- Combination Procedures – At your request or according to your surgical plan, I may perform abdominoplasty (tummy tuck) and mons pubis surgery at the same time to reduce scarring and recovery time.
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Recovery From Mons Pubis Surgery
Recovery from Monsplasty is a critical phase that requires careful attention and adherence to post-operative guidelines to ensure optimal results. Here is what to expect.
- Immediate Postoperative Period – Immediately after your surgery, I will dress your incision wound and provide you with a compression garment to aid in the recovery. You will feel pain and discomfort after your anaesthesia wears out, but I will prescribe painkillers to make you more comfortable. I recommend an overnight stay for my patients for professional monitoring and assistance.
- First Week – I encourage my patients to take light walks around the house the first week to avoid the formation of clots and deep vein thrombosis. Though movement may be difficult and slightly painful, this is a necessary step towards healing.
- Follow-Up Appointments – During follow-up appointments, I will check on your healing progress, ensure that your wound is not developing any infections, and adjust some of the post-operative guidelines in case of any negative changes.
- Swelling and Bruising – It is expected to have bruises or swelling immediately after your surgery. However, depending on how well you care for your incision wound, the swelling will significantly reduce after 1 to 2 weeks.
- Physical Activity – I discourage intense workouts or physical activities for 4-6 weeks post-surgery. Depending on the nature of your job you can resume sedimentary work within 2 weeks.
- Scar Management – Scar management involves cleaning and redressing the incision site to prevent the risk of infection and bad scarring. Applying sunscreen before exposing the wound to direct sunlight will help to minimise scarring.
What Will the Scar Look Like After Mons Pubis Surgery?
The appearance of your scar depends on different factors like:
- Placement of Incision – The length and location of an incision majorly determines the appearance of your scar. During your Monsplasty, I will place the incision below your bikini line or along your body’s creases so it can be easily concealed.
- Suture Technique – The technique I use to close your incision will also determine the appearance of your scar. Some suture techniques put a lot of tension on the wound, causing widened or raised scars. I use absorbable sutures to tighten the mons pubis and close the incision, however, which helps to minimise the scar’s appearance.
- Scar Care – Scar care goes deeper than cleaning your wound and changing your dressings. To have minimal scarring, you must diligently follow my post-surgery guidelines, including applying the recommended ointments and avoiding direct sunlight, which may cause hyperpigmentation on your incision site.
Individual Healing
Genetics, age, individual health conditions, and whether you maintain a nutritious and healthy diet (complete with vitamins and minerals) and a healthy overall lifestyle will also determine how well your scar heals. Refraining from smoking for six weeks post-op and maintaining a healthy lifestyle also contribute to optimal healing results.
Is Mons Pubis Surgery Painful?
Pain and discomfort are inevitable after any surgery. Monsplasty involves incisions, removing excess skin, and suturing the surgical site. The whole process can cause a lot of manipulation or nerve damage. I will administer painkillers to ensure that your post-surgical journey is smooth and comfortable.
Risks and Complications of Mons Pubis Surgery
Like any surgical procedure, mons pubis surgery has a few possible risks and potential complications that may arise during or after surgery. The extent of these complications depends on your health factors and adherence to my post-operative guidelines.
- Infection: If you do not protect the incisional site from dirt and germs, your wound may become infected, which may require the administration of antibiotics or additional treatment.
- Nerve damage: Mons pubis involves manipulating of skin and nerves. Some nerves may be damaged during surgery, resulting in numbness or reduced sensation. In most cases, the sensation returns.
- Bad scarring: Poor wound care habits, such as inadequate cleaning and excess tension on the wound, can cause wound infection or reopening, which may lead to asymmetrical scars.
- Anaesthesia risks: You should mention beforehand if you have any medical allergies so that I can look for more suitable alternatives.
Pregnancy Following Mons Pubis Surgery
I advise my patients to wait until they are fully healed before considering pregnancy again. However, getting pregnant after a mons pubis surgery will not affect the aesthetic outcome of your Monsplasty. There may be changes, however, if excessive amounts of weight gain occur.
Sexual Intercourse Following Mons Pubis Surgery
Sexual intercourse can cause strain on your incision site, causing pain and discomfort. I recommend a waiting period of 4 weeks before resuming sexual activity. It’s critical that you listen to your body and communicate concerns or preferences with your partner for maximum pleasure and reduced complications.
Benefits of Mons Pubis Surgery
Monsplasty helps to remove the extra skin and extra tissue from a large mons pubis, which makes it possible to wear tightly fitting clothing and swimsuits again. There are several pros that come with Monsplasty surgery, including:
Improving the mons pubis contour
Monsplasty involves the surgical removal of stubborn fat and excess skin on the pubic area, resulting in a better-contoured area. Improving the appearance of your mons pubis will also expand your clothing options in that you have a wide array of pre-pregnancy clothing that you can still wear just like before.
Reducing difficulty in urination
When your mons pubis sags excessively, covering your genitals (mons ptosis), you may experience discomfort or difficulties when urinating. Monsplasty addresses this condition by removing the excess skin and fat to make urination easier.
Improved genital hygiene
Excess skin tissues or folds can trap dirt or moisture, making cleaning difficult. A Monsplasty will help to reduce the risk of odour and skin irritation.
Reducing chronic infections
Lack of proper genital hygiene can result in chronic diseases like candidiasis, intertrigo, and cellulitis. Mon pubis surgery is a viable solution.
Improving sex life
A Monsplasty procedure may improve your sex life by increasing comfort and sensation on your mons pubis. It can also reduce your anxiety or self-consciousness and boost your sexual performance.
Who is the Best Candidate for Mons Pubis Surgery?
If you have undergone significant weight loss following pregnancy or bariatric surgery, the stubborn fat cells and saggy skin on your mons pubis make you an ideal candidate for this surgery. If you are having difficulty performing basic tasks like urinating or practising hygiene due to skin ptosis, book an appointment with me today for analysis and a tailored treatment plan.
When Will I See the Results?
You will note a difference in your mons pubis immediately after your surgery. Though swelling, discomfort, and bruising will occur, it is a part of the natural healing process. The swelling will subside within 4 to 6 weeks, allowing you to see a more defined mons pubis, though desired results will take 3 to 6 months to manifest. To preserve results, maintain a healthy lifestyle and stable weight.
Cost of Mons Pubis Surgery in Australia
The average cost of a mons pubis surgery is $5,000. However, depending on your tailored surgical plan, the length of your surgery, and the clinic’s location, a Monsplasty can cost between $3,000 and $8,000. If your Monsplasty is performed strictly for cosmetic purposes, Medicare may not cover the procedure. If I deem it to be medically necessary, it could qualify for coverage.
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FAQs
These are some of my most asked questions about Monsplasty and the recovery journey.
How soon can I resume normal activities after Monsplasty?
You can resume light activities and return to work after 1 to 2 weeks. Ensure that you avoid highly strenuous activities that may reopen your wound. You should also avoid sexual activities for up to 4 weeks post-surgery for optimal healing.
Will there be a visible scar after Monsplasty surgery?
The visibility of your scar depends on proper wound management and the location of your incision. I make incisions below the bikini line to minimise visibility.
What are the risks and complications associated with mons pubis surgery?
Every surgery has associated risks and complications, and so is mons pubis surgery. Some of them include infection, formation of hematoma and seroma, and bad scarring.
Dr. B’s Final Thoughts
Sagging mons pubis can be daunting at times because it can be difficult to eliminate through exercise. Monsplasty is a very effective surgical way to reclaim your body shape after pregnancy. Book an appointment with me for a medical analysis and tailored Monsplasty plan to get your desired results.
References
- Hamdi, M., Waked, K., Deleuze, J., Giunta, G., De Baerdemaeker, R., De Brucker, B., & Zeltzer, A. (2023). The monsplasty: Surgical and functional outcomes using an effective and reproducible surgical technique. Journal of plastic, reconstructive & aesthetic surgery : JPRAS, 84, 287–294. https://doi.org/10.1016/j.bjps.2023.06.007
- Pechevy, L., Gourari, A., Carloni, R., Sauvaget, F., Bertheuil, N., & Goga, D. (2016). Monsplasty after massive weight loss: Assessment of its aesthetic and functional impact. Annales de chirurgie plastique et esthétique, 61(1), e21–e35.
- Placik, O. J. (2016). Surgical risks and untoward outcomes. Female Genital Plastic and Cosmetic Surgery, 154-185.
- Saheb-Al-Zamani M. (2022). Mons Pubis Lift (Monsplasty). Clinics in plastic surgery, 49(4), 479–487.
- Pelosi, M., 2nd, Pelosi, M., 3rd, & Pelosi, M. (2024). The Cosmetic Management of Mons Pubis Ptosis. Surgical Technology International, 44, sti44/1797. Advanced online publication.
- Patoué, A., De Runz, A., Carloni, R., Aillet, S., Watier, E., & Bertheuil, N. (2018). Safe monsplasty technique. Journal of plastic surgery and hand surgery, 52(2), 74–79.
- Yavagal, S., de Farias, T. F., Medina, C. A., & Takacs, P. (2011). Normal vulvovaginal, perineal, and pelvic anatomy with reconstructive considerations. Seminars in plastic surgery, 25(2), 121–129.
- Shaeer O. K. (2016). Shaeer’s Technique: A Minimally Invasive Procedure for Monsplasty and Revealing the Concealed Penis. Plastic and reconstructive surgery. Global open, 4(8), e1019.
- Dudzinski, M. R., & Rader, J. S. (1990). The mons pubis: an excellent graft donor site in gynecologic surgery. American journal of obstetrics and gynecology, 162(3), 722–725.
- Mehdi, K. M., & Kumar, A. (2023). Spontaneous cutaneous endometriosis in Mons Pubis: review of literature. Medical journal, Armed Forces India, 79(1), 105–108.
- Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anaesthesia. Am J Obstet Gynaecol 1946;52:191–205.
