Articles Provided by Dr. Powers of Beverly Hills

Dr Powers is one of a select group of plastic surgeons with experience in the Cohesive Gel Implants study of Inamed Style 410 Implants.

A description of the study follows:

Dr Powers is one of a select group of plastic surgeons who are investigators participating in Inamed Corporation FDA approved study of cohesive gel breast implants (style 410). They are anatomic (teardrop) shaped, textured breast implant made of a silicone gel which is truly cohesive. This means if the outside shell breaks down, the inner silicone gel does NOT leak out or change shape.

Though these implants are considered FDA study implants in the United States, they have been implanted in Europe and throughout the world for many years.

These 410 cohesive gel breast implants can be implanted in first time breast augmentation patients as well as for revision / exchange / reconstruction gel implant patients and for other patients who meet the criteria to qualify for gel implantation.

Patients must also agree to enroll in the mandatory 10 year follow up study for the 410 implant with the Inamed Corporation.

If you are interested in the 410 cohesive gel breast implants please contact us for more information or consultation.

Restoration or reconstruction of a breast has greatly advanced since the days of the radical mastectomy.

If a woman is a good candidate for reconstruction, she can usually expect a breast mound that will fill a bra cup to her desired volume, along with a nipple and areola, if desired. The opposite breast can be made to match by augmentation, reduction or lifting. These procedures are covered by insurance, as mandated by law. In addition, significant breast symmetry as a result of lumpectomy/radiation or multiple biopsies can be corrected with reconstructive surgery. The word "can" is used because breast reconstruction is a matter of choice. Some women choose to wear a breast prosthesis with their bra. Others may choose reconstruction, which is not limited to one's age. The overall health condition and status of the cancer are the issues that determine feasibility.

Consultation with a plastic surgeon prior to mastectomy is part of a comprehensive breast care center program. The patient should be fully informed of her options for immediate versus delayed breast reconstruction. The technique(s) recommended are based upon her anatomy, medical background and anticipated future cancer treatments.

Decision-making in breast reconstruction begins with the simple question of whether breast reconstruction will be part of the woman's recovery process.

Some women know the answer immediately; others need days or weeks to decide. Once the decision is made to go ahead with the procedure, the next question is which technique to select. In each case, the decision is based upon surgical preference and which technique will be better in the face of any anticipated treatments of chemotherapy and/or radiation therapy.

The two most common types of breast reconstruction are the tissue expander/implant technique and the transverse abdominus musculoctaneous (TRAM) flap. A third technique is the latissimus dorsi musculocutaneous flap with a breast implant. The table shown here summarizes and compares these techniques.

With the plastic surgeon's guidance, the most appropriate technique can be selected for breast reconstruction, taking into account the desires, health status and unique anatomy of the individual woman.

The expander/implant technique requires two stages. The first stage of this breast reconstruction is placement of the tissue expander below the pectoralis chest muscle. This procedure adds less than one hour to the mastectomy time with the same overnight hospital stay.

The second stage is the exchange of the tissue expander for the permanent saline or silicone gel filled breast implant. This stage requires general anesthesia, but is usually less than one hour in duration unless a procedure on the opposite breast is added.

Breast implants are confirmed safe by multiple medical studies. Both saline and gel filled breast implants were released years ago by the Food and Drug Administration (FDA) to be used for breast reconstruction and for replacement of older or present gel implants.

The TRAM flap technique uses autogenous, or one's own tissue to create a breast mound. This surgery takes an average of five hours in addition to mastectomy completion with the average hospital stay of five days and an average recovery time of five weeks. The abdominal skin above the belly button is lifted off the abdominal fascia and sutured down to the pubic area skin with replantation of the belly button. The four to five week recovery period is necessary to straighten and strengthen the abdominal walls and muscles. Activity levels usually return to the normal, pre-operative status.

The latissimus dorsi flap with implant is usually used as a salvage technique in the face of previous radiation or surgery. The flap consists of the latissimus muscle with an overlying skin paddle from the back. It usually requires a breast implant to obtain the desired breast shape and volume. The implant is placed below the latissimus muscle after the muscle is passed onto the chest wall through a tunnel at the base of the axilla (underarm). It is a useful reconstructive technique in the face of irradiated breast skin with deformity after lumpectomy and a lack of an adequate volume of abdominal fat.

Nipple areolar reconstruction can be performed at the time of the second stage reconstruction. Or, it can be done as a separate procedure as an outpatient under local anesthesia. The skin on the breast mound is the source of the nipple reconstruction with a full thickness skin graft, usually from the inner, upper thigh skin used for the areolar reconstruction. This skin is usually textured and pigmented resulting in a realistic appearing areola.

An extensive and detailed consultation with the plastic surgeon is mandatory for a patient to be truly informed and guided to make the best decision about breast reconstruction in conjunction with the treatment recommendations from the breast surgeon and oncologist.

All right, we all want to look like Demi Moore. We wouldn't kick the 25-year-old lover out of bed. We all want our ex-husbands to gush over us and shower us with child support in the millions (creative assumption here about the size of Bruce Willis' check, not known fact). And then we wake up, wonder how popcorn managed to go directly from the stomach wall to the top of our thighs, watch a snoring husband pound at the snooze button on a screaming alarm for the tenth time, and then stumble into the shower, where we pinch our breasts into temporary perkiness. Face it: cosmetic surgery is something that crosses a lot of minds when we walk past a mirror, whether you're nineteen or ninety. So, do you wonder when you should really consider cosmetic surgery? (For facelifts, it's earlier than you think.) Wonder how much it costs and should you start saving now? Afraid that you'll end up looking like Michael Jackson? Dr. Mary Powers, has seen it all during her years of practice, and she shares her wisdom and experience freely in the interview below.


iSophia-Our readers should know that you're somewhat of a star in the medical world.

M. Powers--I did a television pilot called Real Radical. I don't like that whole business of having a microphone attached, recording everything you say. You don't feel there's that true one-to-one contact. You don't feel like you have that connection. About the only thing reality television can do for you is make you look foolish.

iSophia-Extreme Makeover makes cosmetic surgery look like a fairy tale, like a dream come true. Is there one thing, one piece of reality that you would give viewers?

M. Powers--This isn't a joke. It's not like saying, "I'm going to try those pants or shoes on and if I don't like them, I'll return them." There are life-threatening issues that can occur. Especially the older the patient gets.

iSophia--Really? I never considered that a facelift could be life threatening!

M. Powers-Once you're over 50, you need to make sure you're in good health. Women are at risk of cardiovascular disease. Heart attacks are the number one killer of women. You need to make sure you're improving your life, not adding to the problems.

iSophia-Here on the West Coast, we see 30 year-olds with Botox and fattened-up lips. Some of these women look like Donald Duck. Who should seriously consider plastic surgery?

M. Powers-- Someone who feels that they've done everything else, and now the only thing that can be done is surgery. Take jowling of the face. There's no treatment except accepting it or a facelift. Fat deposits. Women who've had kids. They work out and lose weight, but the fat remains on the hips, thighs and tummy. Sometimes it just doesn't disappear. That's what it's for. Once you have kids, the breasts go south. There's nothing that will lift them up again. Obesity is a major health problem. People who lose the weight, then have to get rid of the loose skin.

iSophia--Do you get rid of loose skin from the entire body?

M. Powers--It starts from head to toe. Face to neck lift, to arms trimmed up, brachioplasty. Their tummy needs work, that apron of skin that can hang over their genitalia. That part is covered by insurance. It is a health issue. If there is a fold of skin hanging over your private area, you can get infections. There is a total body lift. They hoist the outer and inner thigh skin. That's pretty drastic, but it's the only thing that gets that loose skin up again. The bottom line is: don't get that heavy. Unfortunately, a lot of Americans are overweight.

iSophia--Who would you counsel not to consider plastic surgery?

M. Powers--Someone who has mental instability. There are people who don't see themselves in a realistic way. What they want is not a realistic thing. I remember seeing a young male, 15 years ago. He wanted to look like Michael Jackson. There was a woman, 5'2" middle-aged and overweight. She brought in a picture of Brooke Shields. One of these things where it's clear that there's not going to be a fit. That's not a surgical issue. That's a psychological issue. As a doctor, you have to say, "Is this a realistic goal?" Some people become cosmetic surgery addicts. Then of course, there's the Michael Jackson example that's always brought up. When to say, "Stop!" Now that I have bigger breasts, I want skinnier thighs. When you start pushing the envelope. Having things that aren't realistic done.

iSophia--Isn't a good amount of being sexy just healthy eating and exercise?

M. Powers--You can't control genetics. Sometimes people truly do have physical characteristics that they've lived with all their lives that aren't desirable. Large nose. Extremely large or small breasts or hips. It's not just healthy eating and/or life style. For some things, there are only surgical remedies.

iSophia-What are the risks?

M. Powers-Infection, bleeding, scarring, and asymmetry. Exact risks are specific to the area. Long-term risks are low. That's the reason why plastic surgeons go through so much training. When I see the patient, I evaluate her. Not everybody is in perfect health when they come through the door. Are her heart, lungs and everything else in order, so that she can stand the stress of the 6-hour face life. You need to be a healthy candidate, and then the surgery is relatively low risk. The whole bottom line is to improve the person's life. To get that bump removed. Not to saddle them with some problem of any kind.

iSophia-Botox has become all the rage. Breast implants have increased 600%, from 32,000 in 1992 to 225,000 in 2002. You can get cadaver flesh sewn into your lips. Do any of these trends concern you?

M. Powers--Botox parties. Bringing in this party atmosphere of drinking wine and eating and signing illegal consent forms. It's just silly. It doesn't make sense at all. People think it has a certain amount of glamour. To me, it's totally nonsensical. The Association of Plastic Surgeons condemns Botox parties. Anyone who is doing that is not a board-certified. Anybody can purchase Botox, and say, "I do Botox and collagen." This isn't buying a tube of lipstick. This is injecting material into your body. It should be done by people who are trained--dermatologists and plastic surgeons, but any physician can do it--family practice, gynecologist. You just have to be an M.D. That's why we, as a society of Plastic Surgeons, always stress board certification and board eligibility, to be sure the surgeon has the background, training and proper education, and that they've met those requirement. If someone says they're board certified, they should have expertise and knowledge to handle complications, as well as doing the procedure. You want to look good, but you want to do it safely.

iSophia-It's freaky to me. I'd be hyper-concerned about knowing where the needles had been, and a million other details.

M. Powers--What if it wasn't sterile and you develop a facial infection? It wouldn't be humanity, if everything were 100% perfect.

iSophia-Do you administer Botox?

M. Powers--Sure. All kinds of injectibles. We have Botox and collagen. Collagen used to be from bovine or porcine (pig or cow). Now they have a human-derived collagen. Cosmoderm. That seems to be more gentle and causes less swelling. There's also Cymetra--micronized cadaver dermas. That is used to fill up lines and lips. People felt that would be somewhat permanent. Its cousin is Alloderm. Cadaver rolled into sheets for face plumpers. That's usually in conjunction with something else. Unless you're young, collagen alone won't do the trick. When you're over 40, we have loose, excess skin in places, like the neck, eyes and breasts. Time and gravity takes its toll, especially after childbirth.

iSophia note: Alloderm and Cymetra are made by Lifecell, a NASDAQ company that is publicly traded under the symbol: LIFC. Botox is made by Allergan, AGN: NYSE.

iSophia--Is a facelift good for life?

M. Powers--Any procedure you do, you don't stop Mother Nature, time or gravity. You just turn the clock back. If you paint your car and leave it out in the sun, you'll loose all that benefit. A lot of times, things like liposuction, breast reduction, tummy tuck, it's a launching pad for the patient to get back on track for herself. Those are the people who look the best. They don't look like they were ever 70-90 pounds overweight.

iSophia-So, if I brought in a picture of Demi Moore and said, "Please make me look like that. I want a 25-year-old lover!" How much would it cost?

M. Powers--Remember the bottom line is that the reason stars are popular is that they sell an image. That image is based upon physical features. If you're a man, you can get by being a rugged individual. A woman actor needs to have that appeal. In our society, the appeal is still young or young looking. I don't know how much surgery Demi Moore has had, but she wouldn't look as good as she does if she didn't put a lot of hard work into it. Surgery can't do everything for you. You need to do yoga, running or exercise. People think they'll go from flabby and 50 pounds overweight to looking like Demi Moore. (iSophia note: Dr. Powers is not talking about us here!! We hope.) They're totally wrong. The best results are to get the head start with the surgery, and then continue with the diet and exercise. You also have to have the right frame of mind. You need to balance work and play. You need time for yourself. That's a major issue for most women. They don't allow themselves the time to work on their bodies and their own mental health. That's the challenge for everybody--male and female. To balance work, play, taking care of themselves and their family.

iSophia--Is there a viable alternative to breast implants? What about that surgery that is being performed on mastectomy patients, with living tissue?

M. Powers--Yeah. That's breast reconstruction. I do both cosmetic breasts and breast reconstruction. That is when a woman has lost her breast tissue due to cancer. You're willing to take potion of your body to create another part of your body. That involves expense, scarring and recovery time. With cosmetic surgery, you're taking something normal and trying to improve it to a better appearance.

iSophia-So implants are the best option for the woman who wants to do something about her breasts heading south.

M. Powers--If you want your breasts lifted without implants, you just tighten up the skin. For a woman with D cup, if she wants a perky B-C cup, she can have those, but you're not going to have a perky D. If you have excess skin, it can be lifted. The overall size or volume is the criteria that you examine.

iSophia-How safe are implants?

M. Powers--I'm using saline and gel. The gels are in the market for women who have implants already and want to replace them-when there is a need for reconstruction or in the case of chest wall deformity. The major issue is that if the shell breaks, the gel leaks out. It causes silicone granuloma. In order to remove it you have to remove chest muscle. These women who have leaky breast implants, sometimes they wait seven years and then they have major problems. Cohesive gel implants have been used in Europe for seven years. They give a very natural shape. Ideally, these can be the first and last set a woman has. As long as she's happy with the shape and feel of them, she doesn't have the pressure to remove. It will be available to the general population in 1-2 years. Otherwise you have to go to Europe, if you want to get them, after this study closes in January.

iSophia-So, the appeal of gel over saline is the feel.

M. Powers-- One feels like real breast tissue, and one fills like a water balloon. The other issue is that the saline implants have rippling. Sometimes you can see that rippling on the side. Some women are happy with them. If it does rupture, it's just saline or salty water. That's why the gel implant is appealing. They get the squishiness of gel without the spillage.

iSophia-What's the price of a pair of implants?

M. Powers-- For me, breast augmentations cost in the range of five to six thousand. The overall range can be from $2995-$8000. It's basically whatever the doctor can demand. A face-lift averages $6,000-$8,000. Someone in demand might want to charge $20,000. Do some shopping. Find out what kind of fees are involved. Compare it to someone else. You do get what you pay for.

iSophia-What's the ballpark price on Botox?

M. Powers-- If you're paying $99, chances are that it won't last. It might last 2-4 weeks, and then it is gone. We dilute it in such a way that the person will get 2-4 months of muscle paralysis. Some of this is the story of life: you get what you pay for.

iSophia--At what age should a woman consider work on her face?

M. Powers--That's an individual issue. A woman should consider a facelift when she starts to see sagging of the face and tissue where the jaw line is not as smooth or tight as high school or prom pictures. There really isn't anything except a facelift that will smooth and tighten. Laser treatments can help out. Good skin care. Those are all things to stall the inevitable. Some women are okay with a little turkey skin on their neck. You go from an oval face to a square face. Soft tissues drop. The skin falls and you end up with a square face because you've got the jowls. It's better to do things a little on the early side than the late side. It's much better to do things to maintain, instead of dramatic makeovers. As a saggy 60, you won't get as good of a result as if you do something in your late 40s/early 50s..

iSophia-Is there any way to prolong the inevitable?

M. Power--Everyone can use skin care, especially in Southern California, with the sun exposure. Blotchy lines and wrinkles. The rest is how aggressive you want to be in terms of facial rejuvenation. It also depends on where they are in their life. There are some patients who go through traumatic divorces, where their husband dumps them for a younger woman. One patient was married for 20 years, but felt like she left herself go. The woman had a neck lift, implants and weight loss. She looks great. We turned lemons into lemonade.

iSophia-Okay, okay. We're still refusing to watch Extreme Makeover, but I see your point. Some people, err, perhaps even us, might benefit from cosmetic surgery, provided it's approached with a good grasp on reality. So... Can you make me look like Demi Moore for under $15,000?

Fine art and plastic surgery share the common intersection where imagination meets motor skills. The result is the formation of something new, exciting and aesthetically pleasing. It would be no surprise if many, if not most, plastic surgeons consider themselves artists and have the works of art to prove it.

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