A conversation with Dr. Bill Adams about how he got into plastic surgery, the culture at UT Southwestern, and the ideas that shaped his approach to breast surgery. He also breaks down his current thinking on pocket plane selection, augmentation mastopexy, patient education, and why education and mentorship have been central to his career.We discuss Dr. Adams' path from aspiring orthopedic surgeon to plastic surgeon, the mentors who influenced him, and the lessons he carried forward from UT Southwestern and John Tebbetts. The episode also gets very practical, with detailed guidance on breast measurements, dual plane technique, managing borderline augmentation mastopexy patients, and setting expectations in the social media era. Key topics Dr. Adams' early path into surgeryHe grew up with no doctors in the family and initially wanted orthopedic surgery because of his sports injuries and early exposure to surgeons.A pediatric cardiothoracic rotation, then general surgery, helped him realize he loved operative work but wanted a different kind of precision.A friend, Brett Snyder, encouraged him toward plastic surgery.Why plastic surgery fit his personalityHe describes plastic surgery as meticulous, detail-oriented, and a strong match for his obsessive, highly structured approach.He was drawn to the combination of technical skill, problem-solving, and aesthetics.How biking and friendship shaped his early yearsHe talks about a major Tour de France era biking trip with Brett Snyder and friends.The story highlights the close professional and personal relationships that influenced his development.The UT Southwestern environmentHe credits UT Southwestern for much of who he became as a surgeon and educator.He describes a high-volume, highly demanding culture with strong board preparation, deep pathology, and a strong general surgery foundation.Leaders like Fritz Barton and Rod Rohrich set the tone for hard work, productivity, and academic rigor.Rod Rohrich's influenceDr. Adams emphasizes Rod Rohrich's intensity, work ethic, and leadership.He says the program's culture came from its leaders and that he learned how to work and think like a productive academic surgeon there.John Tebbetts and breast surgeryTebbetts was his biggest mentor in breast surgery and a major influence on his philosophy.Dr. Adams explains how Tebbetts helped him think in tissue-based terms, focusing on the breast envelope and implant fit rather than just cup size goals.He also credits Tebbetts with shaping ideas around patient education and structured planning.His framework for breast augmentationDr. Adams describes measuring breast base width, nipple to fold distance, and skin stretch to guide implant selection and pocket choice.He emphasizes that the goal is to optimally fill the breast envelope with a tissue-based plan.He references the high five process as an extension of that philosophy.Why he prefers dual plane in most patientsHe says he is about 99 percent dual plane because he believes it offers better long-term outcomes.He argues that above-muscle approaches, including subglandular and subfascial, often sacrifice coverage and may lead to longer-term problems.He points out that long-term thinning can make even a technically acceptable above-muscle choice less durable.How he thinks about pocket plane complicationsHe says many problems blamed on dual plane are actually technical errors, such as over-dividing, under-dividing, or dividing too close to the chest wall.He notes that a small subset of very muscular patients may still be better served with an above-muscle approach.Patient education as a core part of outcomesHe says managing expectations is really about education, especially in an era of misinformation from the internet and social media.His process includes a dedicated patient educator, measurements, Vectra 3D imaging, and a structured consultation.He stresses that patients need to understand their asymmetries and plan before surgery so they are not surprised afterward.How he decides when to add a liftHe gives a practical algorithm using nipple to fold length, skin stretch, and vertical excess.He explains when a patient may do well with augmentation alone, when to stage, and when augmentation mastopexy is the right choice.He also discusses choosing between superior medial pedicle and central mound techniques based on horizontal laxity and volume resection needs.Why he favors a horizontal incisionHe says he stopped relying on straight vertical mastopexies because they were less predictable and often left residual skin excess.He now uses a horizontal incision in the crease to better control nipple to fold and improve consistency.He separates pedicle choice from skin incision choice, arguing they should not be bundled together.Leadership in educationDr. Adams talks about directing the UT Southwestern aesthetic fellowship and shaping it into a leader-focused training program.He describes the fellowship's roundtable format, where fellows choose topics and lead discussions instead of being spoon-fed journal club articles.He also reflects on his roles in the Aesthetic Society and its Research Foundation, emphasizing giving back through education.Rapid fire closeHis favorite OR music is classic rock and Motown, often chosen with input from the staff.His favorite instrument is the double ended retractor, which he says is indispensable in breast surgery.Timestamps 00:00 - Welcome, conference plans, and why this podcast focuses on surgeon stories 01:13 - The question that started it all: what shaped Dr. Adams' path 01:29 - Wanting orthopedics, then discovering surgery fits his mindset 02:26 - First surgical rotation in pediatric cardiothoracic surgery 03:22 - Why orthopedics felt too mechanical and why general surgery opened his eyes 03:52 - A biking friendship that helped steer him toward plastic surgery 04:46 - Bruce Shack and the moment plastic surgery clicked 05:39 - Why precision, detail, and ER reconstruction matched his temperament 06:16 - Biking as a major part of life and the Tour de France trip story 07:25 - How UT Southwestern shaped his surgical identity 08:47 - Landing in a competitive residency and training with strong peers 09:42 - Why the residency structure was ideal for integrated plastic surgery 11:05 - The transition from division to department and Rod Rohrich becoming chair 12:03 - Leadership, work ethic, and the Southwestern culture 13:57 - Joining faculty and learning from Rod over eight years as his boss 15:33 - The breast surgery questions that shaped the rest of the episode 16:19 - John Tebbetts as his biggest mentor in breast surgery 17:16 - Resident education and the academic culture at UT Southwestern 18:10 - Early breast reconstruction experience and muscle sparing free TRAM work 19:13 - What Dr. Adams learned from Tebbetts about breast aesthetics 20:12 - Why Tebbetts' teaching style was so direct and technical 21:00 - Tissue-based planning and why the breast should dictate the implant 22:25 - The high five process and carrying Tebbetts' torch forward 23:36 - Why UT Southwestern valued aesthetic surgery and academic influence 24:03 - Subglandular, subfascial, or subpectoral: how he thinks about pocket choice 25:49 - Why he still worries about long-term coverage with above-muscle placement 26:14 - The history of pocket planes and the limits of subfascial claims 27:05 - Why dual plane became the modern standard 28:28 - Why subfascial and subglandular are resurging, and his skepticism 29:56 - His preference for dual plane in most patients 30:20 - Common surgical mistakes that create dual plane problems 31:48 - When very muscular patients may be better above the muscle 32:44 - Why above-muscle placement can reduce blood supply and complicate later mastopexy 34:39 - Patient education in the age of internet misinformation 35:06 - The process of breast augmentation: education, planning, technique, and postop care 36:06 - Using a dedicated patient educator and structured counseling 37:29 - Handling patient requests that conflict with anatomy 37:59 - Measuring with Vectra and turning asymmetry into a shared plan 39:04 - Borderline augpexy patients and how he decides on lift versus implant alone 40:25 - The measurements he uses: breast base width, nipple to fold, and skin stretch 41:47 - When augmentation alone is enough and when mastopexy is needed 42:46 - Inferior mastopexy for long nipple to fold measurements 43:16 - The tissue-based triad and deciding between one-stage and staged augmastopexy 44:40 - Choosing superior medial pedicle versus central mound 45:37 - Why he now favors a horizontal incision to control nipple to fold 47:12 - Separating pedicle choice from skin incision choice 48:08 - Building the UT Southwestern aesthetic fellowship into a leader-making program 50:03 - Why the fellowship avoids tradition Send us Fan Mail Support the show Instagram: @thediependpodcast
