Join Plastic Surgery Practice Co-Chief Editor Keri Stephens as she talks to Anna Steve, MD, FRCSC, (or “Dr. Anna,” as her patients call her) about all things breast reconstruction. A breast specialist at the New York City-based Neinstein Plastic Surgery, Dr. Anna endorses an “elegant” approach to breast surgery—although she’s quick to point out that the reconstruction process can present unique challenges.

In this podcast, Dr. Anna reveals why breast reconstruction is rarely a one-and-done procedure and why referring to post-mastectomy reconstruction as a “free boob job” is deeply erroneous. She also divulges what excites her most in breast reconstruction right now. (Hint: It involves nipple reconstruction.)

Finally, Dr. Anna shares one important aspect of medicine that surgeons are “not historically great” at—and why that should change.

Podcast Transcript

Keri Stephens:

Hi, and welcome to the Plastic Surgery Practice Podcast, a part of the MEDQOR Podcast Network. My name is Keri Stephens, and I’m the co-chief editor of Plastic Surgery Practice Magazine. Today I’m talking to Dr. Anna Steve, a board certified plastic surgeon, and a practitioner at Neinstein Plastic Surgery in New York City, who specializes in breast surgery. Dr. Anna, as her patients call her, recently joined us on a podcast to talk about her unique approach to breast surgery, and she’s here today to talk about breast reconstruction revision considerations. Dr. Anna, thank you for joining me today.

Dr. Anna Steve:

It’s a pleasure, Keri. Nice to see you again.

Keri Stephens:

Great to see you too. So before I start, I saw on social media that you recently attended the Plastic Surgery The Meeting Conference, which took place in Boston. How was it?

Dr. Anna Steve:

It was amazing. Such a great opportunity to connect with colleagues, get up to date on the latest standards and technologies and advances in patient care, and really bringing everyone together in that setting is a chance for us to really brainstorm and be creative about how we can make plastic surgery better for our patients.

Keri Stephens:

I heard you presented at a virtual session. Can you talk about that a little bit?

Dr. Anna Steve:

Yeah. I was on a couple of different panels. One was on breast implant safety, and the second was on the new generation of millennial plastic surgery and how patients are seeking potentially a plastic surgeon earlier age than they were in the past, and what that means for our practice and how that’s changed over time.

Keri Stephens:

That sounds exciting.

Dr. Anna Steve:

Mm-hmm.

Keri Stephens:

Okay. I’d like to get into the bulk of this episode. You and I were emailing back and forth about this topic, and when you did so, you mentioned that women have told you, especially breast reconstruction patients, that they should be grateful for their reconstruction, even though they aren’t 100% satisfied with their results. Personally, I felt that way after my breast reconstruction surgery in 2020, which led me to have to get another reconstruction. But can you address this viewpoint that you should just be happy and you should feel grateful that you got any reconstruction, and why it’s misinformed?

Dr. Anna Steve:

It’s a really negative way to look at things. In terms of your reconstruction. I think there really is a true overlap between a reconstruction type of breast surgery and an aesthetic breast surgery. Really for women on their journey after breast cancer, it’s very important to obtain feeling whole again and feeling that sense of self again. And for some women, the aesthetic part of the breast reconstruction plays a big role in that.

So for me, it’s important to really unpack what it is that the patients are trying to achieve in terms of their reconstructive results, if there’s things that they’re unhappy with and maybe might want to tweak. Also, just educating them and keeping patients educated about what the options are, because a lot of women, I think, are overwhelmed because there’s so many different possibilities and so many direction that reconstruction can go from the get-go, even from your primary reconstruction, whether or not you choose to use your own tissue or an implant-based reconstruction. The whole process can be a little bit overwhelming, partly because there’s so many options. Options can be a good thing, but sometimes wading through them and sifting through them can be a little bit challenging, especially in the setting where you’re dealing with breast cancer, which usually, the primary concern is getting rid of the cancer itself.

Keri Stephens:

How often are plastic surgeons having to revise reconstruction? Can you address the fact that it’s typically not one and done, or is it?

Dr. Anna Steve:

Mm-hmm. That’s a conversation I always have with patients. It’s almost never a one and done. In terms of expectation management, that helps patients feel… prevent that feeling of, I was botched, or my surgery didn’t go as anticipated and now I need another surgery, because the conversation that I like to have is really, “We’re going to choose your primary reconstruction. That’s the first step. Usually there’ll be nips and tucks that happen along the way. The goal of those is to get you back to where you are feeling whole again.” Usually, as long as the surgeon has a safe way to achieve the results and the patient’s expectations are reasonable, you can keep going with further revision surgeries for a number of different stages until you get where you want to be.

So the real stage process becomes, first of all, achieving the aesthetic breast mound that you want. That’s really the shape and the position of the breast tissue itself or the reconstructed breast itself. And then the final stage that some women choose to undergo is the nipple reconstruction and or the ariola reconstruction. That’s generally saved for last after you’re happy with the final mound because the nipple position and the ariola position is more easily placed only once.

Keri Stephens:

Yeah, that’s really good to know. You told me that breast reconstruction patients often use their pre-cancer breasts, and people like me, my situation, [inaudible 00:05:52] breast, pre mastectomy, preventatively, as their inspiration photos, and that’s so different than a typical plastic surgery patient who could use someone online, a celebrity. Can you discuss how this distinction and how it’s important? So using your own self as your [inaudible 00:06:12] versus using someone that’s not you?

Dr. Anna Steve:

Yeah, I think the main purpose of those inspo photos is to really make sure that as the surgeon and patient, you’re connecting on the same visual scale, because language is subjective and descriptions can be subjective and interpretable sometimes. But if you really work together to look at what it is you want to achieve visually, I find that to be very helpful. As you mentioned, the aesthetic patients often use someone other than themselves, and the reconstructive patients usually use themselves as their own inspo. So they’ll bring photos of themselves prior to having breast reconstruction, prior to having their mastectomy. So in some ways they’re very similar actually, in the sense that they have an idea in their mind and when they come to me, they don’t quite look like that idea yet, and they want to know how they can get there.

Keri Stephens:

No, that’s good to know. Can you discuss the misinformation when people say a mastectomy and reconstruction is a free boob job?

Dr. Anna Steve:

I think that’s a very oversimplification that doesn’t give, one, women who have to deal with what it’s like to hear that they have breast cancer enough credit and enough empathy, because that’s absolutely not how it’s experienced, and that’s absolutely not how it should be viewed by the public either. I think that’s an important thing to get rid of that idea. I would say on the positive side that the ability to achieve very aesthetically pleasing results is becoming more and more obtainable. In that sense, it’s great that as a reconstructive patient you could confuse the public into thinking that. I think that speaks volumes for how far we’ve come in the reconstruction and the quality of reconstruction. But for sure that does not address the underlying psychologic burden of what it’s like to go under a reconstructive journey.

Keri Stephens:

No, that’s great. Actually that leads into my last question. What is exciting you most in regards to breast reconstruction right now?

Dr. Anna Steve:

I really think that just the vast potential, there’s so many things you can do, even with respect to nipple reconstruction. If you do a nipple reconstruction and you’re unhappy with the projection, if you do a second nipple reconstruction, often the scar tissue that’s there actually helps you gain more projection. There’s been significant advances in technology that really helps give us an expanded toolkit to help patients achieve what they want. I think more and more as we focus on what patients want and what their ideas are, just exploring that and communicating on a level that allows you to understand what it is that patients don’t like or what they desire, is such an important part of medicine in general. But it’s not one that we historically were great at.

Keri Stephens:

Thank you so much, Dr. Anna. This was very informative. To our listeners, be sure to check back soon on the MEDQOR Podcast Network for the next episode of the Plastic Surgery Practice Podcast. In the meantime, to catch up on the latest industry news, please check out plasticsurgerypractice.com. Until next time, take care.