Eva Sheie (00:03):
The purpose of this podcast is simple. We want you to get to know your doctor before meeting them in person because you're making a life-changing decision, and time is scarce. The more you can learn about who your doctor is before you meet them, the better that first meeting will be. There's no substitute for an in-person appointment, but we hope this comes close. I'm your host, Eva Sheie, and you're listening to Meet the Doctor. My guest today on Meet the Doctor is Anna Steve. She's a plastic surgeon and she's in New York City. It's so good to see you again. Thank you for coming back. 

Dr. Steve (00:40):
Likewise, good chatting with you again. 

Eva Sheie (00:42):
I guess you were on, uh, another one of my podcasts called The La Jolla Cosmetic Podcast, where we debated breast size, shape, and trends, east versus west coast. So that was a good one and it, I'll link that in the show notes if anyone wants to go hear our lively debate about breast implant style. That was a good time. 

Dr. Steve (01:01):
Yeah, that was fun. 

Eva Sheie (01:03):
So tell us about yourself and then we'll talk about social media a little bit. 

Dr. Steve (01:07):
Sure, yeah. So my name's Dr. Anna Steve. I'm a plastic surgeon in New York City. I specialize in all things breasts, so all sorts of breast enhancements including breast reconstruction revisions for people who haven't reached their final desired aesthetic as well as tuberous breast reconstruction and breast enhancements of any kind for sort of women of any age. 

Eva Sheie (01:29):
Do you enjoy breast implant problems or breast problems in general? 

Dr. Steve (01:34):
Well, I don't enjoy the problems, but I like the challenge of trying to solve the problems and that's sort of what plastic surgery is all about, is sort of offering solutions for people who have a frustration that they've reached the limits for how much they can improve it on their own. And that's what I truly love about plastic surgery. And so I do see women who've never had breast implants before and they're in, you know, embarking on the journey for the first time as well as women who have had breast implants in the past, enjoyed them for a number of years, but for whatever reason have encountered a change in their life that's changed how they look or a change in the shape and feel and are looking for a solution for how to either improve them or increase size, decrease size, restyle them, change the position in some way. 

Eva Sheie (02:21):
You said something curious about couldn't solve the problems on their own. And I wonder how would you solve breast problems on your own? 

Dr. Steve (02:31):
Great question. So for some women who are struggling with a significant size that's burdened to them in terms of problems with back pain, neck pain, that sort of thing, those women are often seeking solutions that involve a breast reduction. And in those cases they've often reached a limit. They've maxed out their exercise and for some reason they were born with larger breasts than their shoulders and neck actually support comfortably. And in those cases, you know, if they've reached their optimal weight and still have a problem with large pen breasts, breast reduction is a nice solution for them. Similarly, um, while I specialize in breast enhancements, I also perform a full spectrum of body surgery. So I find in women post pregnancy, they're more frustrated with problems of excess skin than they are excess weight or problems with muscle separation. So to some degree people can strengthen their core, but if you've got a separation like a diastasis recti, which is a separation between the abdominal muscles, there's really no way to fix that regardless of like the amount of exercise you do without putting those muscles back together. And the frustrating part about having excess skin is you can't really exercise your skin. So for those women who have that stubborn bit of excess skin that's persisted post pregnancy and they're at their optimal weight, they often find the excess skin actually looks worse post pregnancy. And so the solution for that is to remove the excess skin. And those are solutions that a lot of women seek because they've maximize what they can do on their own and are still at a point where they don't quite feel comfortable in their own skin. 

Eva Sheie (04:17):
For someone who's in this situation and doesn't necessarily want to have breast implants, what can you do instead? 

Dr. Steve (04:25):
Great question. So a lot of women are seeking non implant-based solutions. Typically that involves a combination of strategies that might incorporate a breast lift and fat transfer is really making its way into breast enhancement. So that's removing stubborn fat from any area in the body and then transferring it to the breast to create some natural volume. I use fat transfer in the breast a lot to combine with an implant for women who want a more natural looking breast augmentation used in breast reconstruction revisions a lot for women who have some contour challenges or some mild asymmetries between the sides. And then I also do breast fat transfer for a lot of women who wanna breast lift without an implant and they just wanna restore a little bit of natural volume to the upper portion of the breast. In rare cases we do breast fat grafting alone with no other enhancements for women who just want sort of a modest change in volume or they wanna add a little bit of volume to sort of hide their rib cage a little bit because they're very thin. I find the patients who benefit most from fat transfer only to the breast are really thin patients who don't have that much to begin with. So a small amount makes a meaningful difference. 

Eva Sheie (05:40):
And if they're really thin, do they even have enough fat to move or is that a challenge too? 

Dr. Steve (05:45):
We can always find fat from somewhere <laugh>. Um, there's also some off the shelf fat products that can be used in in women who don't have enough fat on their own or combined with fat transfer in, in, in people who have a very minimal amount of fat. 

Eva Sheie (05:59):
Where does that fat come from? 

Dr. Steve (06:01):
So that's harvested from cadavers just like some of our other surgical tools. So it's all of the cells that would cause problems if you transferred cells only from someone like a donor, like a husband or a person like that, people often wonder if you could donate fat, you can't donate fat. 

Eva Sheie (06:22):
I have wondered this a lot actually. 

Dr. Steve (06:24):
Yeah. Specifically, um, husbands looking to support their significant other wonder if they could donate fat. Unfortunately if we tried to donate fat from another living human with the normal cells there, you would reject it. But in the situation where we remove it from a cadaver and that fat is processed in a way to prepare it to inject into the body, um, you don't mount a rejection response. 

Eva Sheie (06:49):
Interesting. Yeah. When you say off the shelf fat products, it almost sounds like you could go to the fat store and and just pick some up for wherever you need it. 

Dr. Steve (06:59):
Yeah, it's rare that people are fat shopping. Most people are trying to get rid of it. But <laugh>, 

Eva Sheie (07:04):
I'll trade you my fat for something better. <laugh>. How has your breast reconstruction training and your experience with that patient informed the way you approach your cosmetic patients? 

Dr. Steve (07:16):
I find there's so many similarities in terms of the line between the two. It's definitely a gray line and I find the breast reconstruction practice has really influenced the strength of my breast revision practice because the principles are so similar when you're thinking about each individual and tube rest breast is the same. Each individual has such a unique problem and you need to use your toolbox to solve the problem and create an individualized custom approach to deliver the results that the patients are interested in. And that's what breast reconstruction's all about. Every situation is a little bit unique and a little bit different and a little bit challenging. So it's more about relying on sort of like the tools that you have and coming up with creative solution rather than following a step-by-step approach that's the same cookie cutter approach every time. And that's really something that's unique to plastic surgery as a field as well. 

Eva Sheie (08:17):
Is there a patient you can think of that illustrates this? You know, is there a story you can tell us about somebody that really illustrates this way that you think about breast surgery? 

Dr. Steve (08:29):
Yeah, so I think one of my most recent breast cancer reconstruction revisions is a great example. She had breast reconstruction after her mastectomy on one side and had a balancing procedure on the other side. And at the end of that journey, she lived with her reconstruction as, as it was for a number of years, but she felt like it didn't really give her back the aesthetic that made her feel whole again. And so in her case, she came seeking a solution for better symmetry, a slightly more natural looking result, and she had some significant contracture on the breast reconstruction side that caused her discomfort. So it was a kind of a combination of an aesthetic challenge as well as a functional challenge. And for her it was a reminder of her journey with breast cancer not being sort of totally at the end of her journey. 

(09:25)
And so in her circumstance we sort of talked about all the different tools we had and all the different tools we could use to provide an enhanced result. And we used a combination of a lot of things. We used an internal bra, which I use a lot in both breast reconstruction and breast revision. We used fat transfer to add some natural tissue. We used two different size implants because of course you had a normal breast on one side and no breast on the other side. And then we used breast lift techniques on the unaffected side to create a higher, tighter look on the side that was unaffected by the breast cancer. And so that was a good example of sort of using all of those techniques and using all those tools. And also someone who kind of crossed the line between aesthetics and reconstruction. And in the reconstruction world she'd been orphaned a little bit because they had, you know, I think a lot of women in that circumstance are made to feel like they should just be happy with their reconstruction because they had a reconstruction for whatever reason. 

(10:26)
You know, they should be grateful for that. And a lot of those women actually unfortunately feel like they are being ungrateful when they're not totally satisfied with their reconstruction, even if there's not a problem. And so I think that really demonstrates the how important the aesthetic component of it is and how important that aesthetic component can be actually to the breast cancer reconstruction journey as well. Most of those women I find are they're, they're looking to sort of feel that their aesthetic matches them feeling whole again. And I think that's, you know, something that if their reconstruction in its early phases hasn't provided, it's important for them to know that there are more options out there available to them. 

Eva Sheie (11:12):
If you had a reconstruction that didn't go well and then you were forced to look at that every day and be reminded even five or 10 or 15 years after you beat breast cancer, I think that would be pretty unpleasant 

Dr. Steve (11:26):
Yeah. 

Eva Sheie (11:26):
To live that way. 

Dr. Steve (11:28):
Yeah. And I gratefully in my breast reconstruction training, we did a lot of optimizing. So we did a lot of secondary and you know, even beyond secondary surgery to sort of optimize outcomes. That was a big part of my training and so that really taught me how much achieving that like final aesthetic can make a difference in someone's journey. 

Eva Sheie (11:50):
Yeah. 

Dr. Steve (11:51):
And it's tricky sometimes in the, in the reconstruction world, we get overburdened by the amount of new breast cancers that needed to be treated and primary reconstructions that needed to be done, especially in some of my training in in Canada. And so I think sometimes those patients who haven't quite reached their final aesthetic are just a little bit lost in that world and they get, you know, pushed down the waiting lists and that sort of thing. 

Eva Sheie (12:18):
Depending, well Canada is certainly its own system and I think in aesthetics, just writing about it and marketing procedures, you know, I had crossed over into breast reconstruction a lot but didn't really understand how the system worked until I had a friend go through it. And if you are lucky, you're, you are in a system, in a healthcare system where all of your care from the beginning to the end, the chemo, the reconstruction and the radiation are all carried out by a team of people who talk to each other. But not everyone gets that experience. And even if you do, you don't know if the plastic surgeons in that system are great. So we always had this idea that you could choose your own plastic surgeon for your reconstruction but didn't see the bigger picture that if you're in a system like that, you may not actually really get to choose. And if you do, you're on your own. Like you have to figure all of that out by yourself. And that's a lot of work when you're going through cancer treatment. 

Dr. Steve (13:21):
Yeah. It's a tricky system to navigate. And I think the other important thing to understand is breast reconstruction is a process. So just because you didn't achieve your desired outcome with the first reconstruction doesn't mean that you had a bad team or a bad surgeon or were in a bad system. There's just, the primary goal typically during that stage is to make sure that the cancer is treated and the cancer is gone. So the primary goal is a little bit different, whereas sometimes at a later stage you have the benefit of time and knowing, you know, that the cancer, which is the most important thing, is taken care of and then you can focus a little bit more on the aesthetics later. 

Eva Sheie (14:01):
Well that was, that was a long way around to the cosmetic approach and I think it's always really valuable to patients when surgeon like yourself has the reconstructive experience and is bringing that to the table. And when you were describing your patient, it sounded like it was really like six different procedures <laugh> in in one person. 

Dr. Steve (14:23):
Yeah. But that's the sort of toolkit approach I think.  

Eva Sheie (14:27):
Mm-hmmm <affirmative>. Mm-hmm <affirmative> very well-rounded. So you've mentioned Canada a few times and I heard you say process <laugh>. Are there other words that you say that are very Canadian <laugh> about? 

Dr. Steve (14:39):
It's mostly about, but I, I hear it the same as you say it. So <laugh>, 

Eva Sheie (14:44):
I'm from Minnesota, so I get it. I tried to get rid of it, but sometimes it still shows up. How did you end up back in New York City? 

Dr. Steve (14:53):
So I did some of my subspecialty training in New York City and while we were here my husband and I fell in love with the city and the energy. There's really no place like New York City and I see that in my patients. I see that in my colleagues and it's really a motivating place to be and work and live. 

Eva Sheie (15:14):
What do you love about your job? 

Dr. Steve (15:16):
I love everything about my job. And I think that's what makes it easy to, you know, 

Eva Sheie (15:21):
And you just lit up like a Christmas tree when I asked you that <laugh>. 

Dr. Steve (15:24):
Um, I think in terms of a surgical specialty, it's the most unique specialty because we really do offer solutions that sort of reconstruct and recreate and optimize outcomes rather than taking something away that's very unique to plastic surgery. And I do like that sort of, you know, toolkit that it provides you with to sort of customize the approach. I'm fortunate to work at an excellent office and all my colleagues share the same like spark and love for what they do. And that makes Workday a nice, a nice environment to sort of go and have a nice team as well. 

Eva Sheie (15:58):
There's this campaign a few years ago called, I look like a Plastic Surgeon, do you remember this? 

Dr. Steve (16:03):
Oh yeah, yeah, yeah.

Eva Sheie (16:03):
And I, I was trying to figure out how to ask you if people are surprised when they see you and find out that you're a plastic surgeon because you don't look like a plastic surgeon <laugh>, but that's not fair because who looks like a plastic surgeon. 

Dr. Steve (16:18):
Yeah. It's interesting. I would say the, like most resounding theme among my patients is, you look too young to do this. And I have our nurse injector to thank for that. But aside from that, I'm not sure what makes someone look like a plastic surgeon aside from maybe if I put my scrub cap and a mask on, I could fool somebody. 

Eva Sheie (16:36):
Into thinking you are one? Mm-hmm. <affirmative> or not. 

Dr. Steve (16:38):
Yeah. 

Eva Sheie (16:39):
Okay. Outside of work, you have lots of reasons to be joyful away from the office. Can you tell us about them? 

Dr. Steve (16:47):
So my family is what I spend, um, most of my time and energy enjoying outside of the office. So we have two young kids, they are one and three and so they're sort of loving, you know, New York City from a totally different perspective. So we explore a lot of the parks, we're getting them into, we're trying to seek out all the places we can to get our, uh, young Canadian born sons skating. So we spend a lot of time, uh, <laugh> ice skating, finding ice time. Yeah. And then we sort of, um, enjoy the city through food, which is a great way to explore all the different areas of the city. We're sort of on the hunt for New York's best Almond Croissant and we've probably eaten about a hundred to 150 different slices of pizza. <laugh>. Wow. 

Eva Sheie (17:36):
Someone told me earlier today that there are over 30,000 restaurants. That's crazy. And that you could go to a different one every day for the rest of your life and you wouldn't make it to them all. 

Dr. Steve (17:47):
Yes. 

Eva Sheie (17:48):
So how almond croissants do you think there are to try? 

Dr. Steve (17:51):
Oh, I don't even know, but we've got a long list of like, you know, the, the next 10 spots. 

Eva Sheie (17:56):
Is this also a Canadian thing? 

Dr. Steve (17:58):
No, that's just something that we find if we choose a food to sort of like do a bit of a comparison, then it gives us sort of a, an area of the city to go to, to explore as a family. Cuz we go sort of to all the different areas. Our, one of our favorites is in Brooklyn just across the way, and that sort of takes us over to that like, beautiful boardwalk in Brooklyn Bridge Park. So it's a nice way to sort of, rather than choosing a destination in terms of like where you wanna go in the city, we choose like an almond croissant shop and then explore the area. 

Eva Sheie (18:34):
I like it. Well, in Austin the equivalent would be a, the breakfast tacos we would go all over the city, so.

Dr. Steve (18:41):
Oh, I was gonna say barbecue. We went to Franklin's Barbecue actually as a family. <laugh>. 

Eva Sheie (18:46):
Oh. How was that? 

Dr. Steve (18:47):
It was great. Yeah. 

Eva Sheie (18:48):
Did you have to stand in the line? Yeah, 

Dr. Steve (18:50):
Double stroller and all. 

Eva Sheie (18:53):
Oh wow. I hope it wasn't too hot that day.

Dr. Steve (18:55):
No, it was like a little off season. So the line was like shorter than usual, but 

Eva Sheie (19:00):
I got the best tip from my hairdresser. If anyone's in Austin and wants to go to Franklin's, go at 1:30. 

Dr. Steve (19:05):
Oh. 

Eva Sheie (19:06):
And stand, stand in the line anyway. And there's a guy who holds a sign that says Last Man Standing and that guy is guaranteed to eat and no one after him is, but the truth is about 30, maybe 40 more people after that guy will still get to eat. 

Dr. Steve (19:23):
Oh. 

Eva Sheie (19:23):
You just might not get one or two things. They might run out of something. 

Dr. Steve (19:26):
Amazing. Well, the, the plastic surgery meeting, one of the big plastic surgery meetings coming up is in Austin. So 

Eva Sheie (19:33):
October. Yeah. First time. 

Dr. Steve (19:35):
We'll look forward to returning. Lots of fun stuff in Austin. 

Eva Sheie (19:39):
Is there anything else you like to do outside of work for yourself?

Dr. Steve (19:43):
I do. I, I energize, I think by staying active. So I like to run in the park. I'm a new sort of, uh, member of Barry's. It's like a sort of hit style workout with lots of locations. I don't know if they have one in Austin, but we do a lot of team workouts as well, which is a nice way to sort of connect with colleagues outside the office. 

Eva Sheie (20:07):
If someone's listening today and they wanna learn more about you, where should they go? 

Dr. Steve (20:11):
So you can follow us on Instagram. I'm Anna k Steve MD as well as Twitter, 

Eva Sheie (20:17):
Do you actually tweet? 

Dr. Steve (20:19):
<laugh> I shouldn't say I meant to say that makes me seem so old. TikTok is actually the other like social media outlet that I would say I try and put out the most like educational content and TikTok is a little bit more in interactive, so I have lots of people who ask questions and then you have the ability to sort of answer on that avenue.

Eva Sheie (20:39):
Yeah. Doctor Twitter is interesting and fun to follow, but it's it's way more doctor to doctor than doctor to patient.  

Dr. Steve (20:47):
Yes, yes. Yeah, Twitter is a little bit more like academic and a little bit more focused on like colleague to colleague. And I think the, the most fun part of social media for me is sort of exploring what types of questions that patients have and what sort of education that they're seeking, which is something that, a benefit that I didn't realize social media would bring to my practice, but it really helps me understand sort of what patients are thinking. So I love the engagement both on Instagram and TikTok. 

Eva Sheie (21:17):
So if people DM you on Instagram, are they actually gonna get you? 

Dr. Steve (21:20):
Yeah, yeah, yeah. Yeah. I love the, the dms are a great way to ask a question that you maybe don't want to put out there to the whole crowd. And then if you're interested in like connecting about a consult, um, lots of people dm just to see sort of what the, the basics of like how to get set up would be. So I connect them all with my surgical coordinator and then she reaches out and we can make an appointment from there. 

Eva Sheie (21:44):
Well thank you for, uh, joining us today on Meet the Doctor. It's such a privilege to hear your story. 

Dr. Steve (21:49):
Well thanks for having me. 

Eva Sheie (21:54):
If you are considering making an appointment or are on your way to meet this doctor, be sure to let them know you heard them on the Meet the Doctor podcast. Check the show notes for links including the doctor's website and Instagram to learn more. Are you a doctor or do you know a doctor who'd like to be on the Meet the Doctor podcast? Book your free recording session at Meet the Doctor podcast.com. Meet the Doctor is Made with Love in Austin, Texas and is a production of The Axis, t h e a x i s.io.