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Who are the candidates?

TX Health Magazine Discusses Breast Augmentation with Richard Reynolds, M.D.

Breast augmentation is one of the most popular procedures for plastic surgeons across the country. Besides those just seeking the cosmetic benefits, there are many women wanted to regain their femininity after a mastectomy. TX Health talked with Dr. Richard Reynolds, of Reynolds Plastic Surgery Center, about this medical practice.

What is the first step for someone seeking augmentation?

The first step is to speak with a plastic surgeon about options. The reason the person is seeking augmentation will help determine her options. For purely cosmetic procedures, only saline implants are available. If there is a congenital defect or reconstruction after breast cancer surgery, then silicone implants are available. Other issues to be discussed are placing the implant above or below the muscle and what kind of implant to use, whether it's textured or smoothed. There are benefits to each of those that they should discuss with their surgeon.

How would you work with someone who just wants to increase their size?

I would talk to the individual to find out more about their motivation for an augmentation. Why is she interested in having an augmentation and I would make sure her expectations are realistic and that she's a good candidate for the procedure. We'll make some measurements regarding her symmetry, size and breast width. From those measurements and after discussing the desires of the patient, we'll devise a plan together.

How does someone decide whether they want the implant beneath the muscle or above?

All implants form a fibrous capsule around them because it's a foreign body. Sometimes this becomes more evident with time, but the majority of time it's not noticed by the patient. Putting the implant below the muscle decreases the possibility of this problem. Sometimes putting it above the muscle will get a better result. This is especially true in someone with a mild degree of 'droopiness' of the breast who desires limited incisions.

What type of procedure is easiest in terms of placing the implant?

The majority of patients are best served with the incision in the crease underneath the breast. It usually heals well and is well hidden after the surgery. It also allows the surgeon the most precision in placing the implant and usually produces a maximal result.

What are the best options as far as breast reconstruction?

There are several options for breast reconstruction. The good choice, if it's possible, is to do an immediate reconstruction at the time of the mastectomy. The general surgeon makes an incision to remove the breast, but most of the breast envelope is left in place. A plastic surgeon can put something in that envelope to keep it expanded temporarily or to put a permanent implant or the patients own tissue in that skin envelope. If this isn't possible, or if the patient is going to receive radiation, sometimes it's better to wait.

Some general surgeons are very good about discussing the option of immediate breast construction with patients. If we work with the general surgeon at the time of the mastectomy, we usually design the incision together. The general surgeon removes the breast and then the plastic surgeon will fill that breast envelope with either tissue from the abdomen, the back, an expander, an implant or a combination.

What is your greatest joy in the work that you do?

My greatest satisfaction comes from my patient's satisfaction as a result of the surgery, whether it's cosmetic or reconstructive. It usually makes a significant difference in their life and in their self-esteem. Plastic surgery is often a procedure that the patients look forward to and are happy that they did it.