Mons pubis reduction
What is the mons pubis?
The mons pubis is contiguous with the vulva and, inferiorly, divides into the labia majora. It is a naturally prominent structure that lies in front of the pubic symphysis (the part of the bony pelvis that can be felt at the lowest aspect of the abdomen). The skin is heavily laden with hair follicles and beneath the skin the content is mostly fatty tissue. There are very few nerves within the fatty tissue but there is an abundance of blood vessels.
Prominence of the mons pubis is not exclusive to women with a raised BMI. It also occurs in women considered to be in the normal weight range (for their height), particularly in those who have been previously overweight. Extra fat deposition in these areas can be particularly stubborn to shift even after effective overall weight loss.
The 3 pictures above depict the mons pubis in 3 different women. The appearance of the vulva is different in each woman. The mons pubis rises above the pubic bone, elevated by a subcutaneous fat pad. It is contiguous with the labia majora below.
Why do women request mons pubis reduction?
- Dragging sensation.
- Feeling of a bulge.
- Impression of carrying a weight, particularly when moving around.
- Irritation when wearing tight clothes.
- Increased, localised sweating.
Some women are bothered by the prominence of the mons pubis and how they perceive that it affects their appearance and self-confidence.
There can be little doubt that the most effective way to reduce the size of the mons pubis in overweight women, is by sensible weight loss. However, this is not effective for all women and many will need to consider other options such as surgical reduction. Liposuction, liposculpture and mini-abdominoplasty are rarely effective in reducing the size of the mons pubis.
For a minority of women, the problem is that the skin sags and is excessive without the presence of over abundant fat tissue. The most common causes are age-related thinning and stretching of the skin with loss of subcutaneous connective tissue. Less commonly these features result from massive weight loss where fat deposits have been eliminated but the stretched skin remains.
This patient has managed to achieve significant weight loss and then undergone an abdominoplasty. She remained concerned by the weight, prominence and discomfort associated with the mons pubis and labia majora. There had been little or no change in fat deposition in this area and the abdominoplasty had no effect on the enlarged mons pubis.
This patient has a normal body mass index and has not had any significant weight loss. She complained of being aware of increased prominence of mons pubis area from her late teenage years. She had become an exotic dancer and was bothered both by the friction when wearing Lycra and the appearance of the lump which was much more prominent when she was standing.
How surgical reduction of the mons pubis is performed
The operation can be carried out under a general anaesthetic or regional block. Local anaesthesia is always applied to the wound.
The length and nature of the incision is determined by the size and shape of the mons pubis. The wound is typically elliptical so that the final wound, when closed, is transverse.
Excision of the excess skin is followed by mobilisation of the subcutaneous fascia. This means that when the wound is closed it can be done without any tension.
A wedge of the fat layer is excised taking care with haemostasis. The amount of fat removed must be judicious in order to achieve the desired outcome.
The wound is closed in 3 or more layers; 2 or 3 layers of fat closure, closure of the fascia, then closure of the skin. Dissolvable sutures are used in all layers.
A pressure dressing is applied to the wound. This reduces the risk of bleeding and bruising in this very vascular area.
Surgery is covered by intravenous antibiotics given during surgery and an oral course of antibiotics to be taken for 5-7 days after surgery.
All patients will be admitted overnight. None are discharged on the day of surgery. Some patients may require an extra night in hospital.
You will not be able to drive for 1-2 weeks. Return to work should not be less than 7 days and will depend on the nature of your work.
Post surgical review will have been organised for you. If you have any concerns after surgery then please contact Dr Onuma’s office.
Although more than 90% of healing has taken place by 6 weeks, it will take another 6-10 weeks for the skin wound to completely heal.
Healing of the skin wound and reduction in scar formation is encouraged by massaging Bio-Oil or hyaluronic acid into your wound. You will receive advice about when to commence this.
Before surgery: Elevation of the mons pubis with a large fat pad and associated stretching of the skin.
6 weeks after surgery: The mons pubis is no longer elevated. The skin wound healing is almost complete.