Kids' Book on Plastic Surgery

When she was pregnant with her son Junior, who turns nine this month, Gabriela Acosta ballooned from 115 pounds to 196. Acosta lost the weight but wound up with stretched, saggy skin. Even her son noticed it. He told her that her stomach looked "pruney," the result, he thought, of staying in the shower too long. So the 29-year-old stay-at-home mom scheduled a consultation with Dr. Michael Salzhauer, a board-certified plastic surgeon in Bal Harbour, Fla.

Acosta told Salzhauer that she wasn't sure how to talk to her son about the procedures she was considering. That's when he showed her the manuscript for his children's picture book, "My Beautiful Mommy" (Big Tent Books), out this Mother's Day. It features a perky mother explaining to her child why she's having cosmetic surgery (a nose job and tummy tuck). Naturally, it has a happy ending: mommy winds up "even more" beautiful than before, and her daughter is thrilled.

The reassuring tale helped win Acosta over—she scheduled breast augmentation and a tummy tuck. Since February, when she had the surgery, she and Junior have read the book a half dozen times, and she says it helped him feel excited rather than scared. "I didn't want him to think [the surgery] was because I was hurting. It was to make me feel good," she says.

That message seems to have gotten through. Instead of being uncomfortable about the surgery, Acosta says her son actually spoke up about it at a big party. "Did you see her new belly button? It's so pretty!" he said of his mom. "I think he was proud," she says.

What's the market for a children's picture book about moms getting cosmetic surgery? No one specifically tracks the number of tummy-tuck-and-breast-implant combos (or "mommy makeovers," as they're called), but according to the latest numbers from the American Society of Plastic Surgeons, breast augmentation was the most popular cosmetic surgery procedure last year, with 348,000 performed (up 6 percent over 2006). Of those, about one-third were for women over 40 who often opt for implants to restore lost volume in their breasts due to aging or pregnancy weight gain. There were 148,000 tummy tucks—up 1 percent from the previous year.

Salzhauer got the idea for a book after noticing that women were coming into his office with their kids in tow. He says that mysterious doctor's visits can be frightening for children. "Parents generally tend to go into this denial thing. They just try to ignore the kids' questions completely." But, he adds, children "fill in the blanks in their imagination" and then feel worse when they see "mommy with bandages," he says. "With the tummy tucks, [the mothers] can't lift anything. They're in bed. The kids have questions."

"My Beautiful Mommy" is aimed at kids ages four to seven and features a plastic surgeon named Dr. Michael (a musclebound superhero type) and a girl whose mother gets a tummy tuck, a nose job and breast implants. Before her surgery the mom explains that she is getting a smaller tummy: "You see, as I got older, my body stretched and I couldn't fit into my clothes anymore. Dr. Michael is going to help fix that and make me feel better." Mom comes home looking like a slightly bruised Barbie doll with demure bandages on her nose and around her waist.

The text doesn't mention the breast augmentation, but the illustrations intentionally show Mom's breasts to be fuller and higher. "I tried to skirt that issue in the text itself," says Salzhauer. "The tummy lends itself to an easy explanation to the children: extra skin and can't fit into your clothes. The breasts might be a stretch for a six-year-old."

The book doesn't explain exactly why the mother is redoing her nose post-pregnancy. Nonetheless, Mom reassures her little girl that the new nose won't just look "different, my dear—prettier!"

It remains to be seen how many plastic surgeons will recommend the book to patients. Richard D'Amico, president of the American Society of Plastic Surgeons, who gives the book a B grade, says he would "make them aware that it's out there and leave it up to the patient's discretion." He says the illustration (specifically the breasts) look somewhat "overdone," since most moms are just looking for restoration.

Child psychiatrist Elizabeth Berger, author of "Raising Kids With Character," likes the idea of a book for kids. "If the mother is determined to pursue cosmetic surgery, I think it's terribly important to discuss it with the child," Berger says. But she says the book is incomplete. She wishes that the mom had just said something like, "This is silly, but I really want it anyway," she says. "That is more honest and more helpful to the child."

Berger doesn't want to come across as anti-cosmetic surgery, but she notes that it can be difficult for small kids to understand. "The younger the child, the more mysterious and potentially hurtful the mother's absence, or mother being out of commission, or mother looking like she's been beaten up, will be," she says. Small children are "concrete" and "sensible" and think "you go to a doctor because you're hurt or sick," she says. After considering how their children might react, she says that "some mothers may realize that the total burden of the child's anxiety might be a side effect of the procedure they hadn't quite thought through and that might inspire them to postpone it until the child is older."

Despite the marketing nickname "mommy makeover," which can sound like a trip to a day spa, these are serious surgeries with potential complications that can require additional procedures—and disruption for kids. With breast augmentation, for example, the initial operation is not likely to be the last. Implants may last 10 or more years, but they do not last a lifetime, according to the FDA. About a quarter of all implant patients have to have another operation within five years due to problems like leaking, breast asymmetry and encapsulation of the implants.

Then there are the body image issues raised by cosmetic surgery—especially for daughters. Berger worries that kids will think their own body parts must need "fixing" too. The surgery on a nose, for example, may "convey to the child that the child's nose, which always seemed OK, might be perceived by Mommy or by somebody as unacceptable," she says.

The book doesn't go into any medical detail. "They should do more about what the surgery is," says my own eight-year-old daughter. "Kids," she says, will want to know more about "what they're going to do to you." But on the other hand, if they knew more about the procedures they might not want their mothers to go through with them. As my daughter points out, "a five-year-old is going to be horrified that their mom is getting water balloons put in her breasts."

Salzhauer knows that not everyone will like his book. "There's a good percentage of your readers who are dead set against plastic surgery, who see it as a sign of the decadence of Western civilization," he says. "But when done by a properly trained board-certified plastic surgeon, it really does help make lives better." Salzhauer may someday get a chance to test that theory—and his book—at home. His wife hasn't had any work done yet but is pregnant with her fifth child.

Click here for our guide to getting breast implants safely.