Our of town patients: it can be a real challenge for both patient and surgeon.

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Last week I received a fat snail mail envelope from a young lady requesting a constitution for breast implant removal and replacement and breast lift.   She had had previous surgery with implants too large for her build.

She sent some pretty good photos of her current appearance but no photos of her pre implant self.  She send voluminous dramatic handwritten prose about her experience and what she didn't like  and why and how she would like the next implant experience to be better.  She did not include any records of her previous surgery which can be extremely helpful.  

She referred to me as her "titty fairy god mother" which made be a bit nervous.

Also in the envelope were several soft porn photos of young women's breasts that had obviously been photoshopped that showed the look she was hoping to achieve.

The return address on the envelope was the southeast, at least 2000 miles away from my office in Seattle.    

So what do a do with a consultation request like that?     

Had she been local, the consultation would have gone like this:

Initial consultation with a kind but firm reality check and a release so I could examine the former surgeon's records.  

Then another visit with the former records in hand and my voluminous before and after book to show her what sort of result I can, on a good day, achieve.  This would be hence another reality check.  

And then finally a preoperative visit where I really get very specific as to what I can and cannot do.  For example, a implant revision requiring a breast lift is NEVER, NEVER, NEVER going to look like a scarless, soft porn photoshopped breast in a magazine.  

If she and I come to an agreement on what a good result really is, then surgery will be a go and I will do my best for her to get the very best result I can.   If she still has her heart set on that soft porno photo and still thinks I'm her "titty fairy god mother", I won't operate on her.   There is nothing more discouraging for a surgeon to see a patient post op who is sorely disappointment in a result that I spent blood, sweat and tears to achieve.  She feels ripped off by the  amount of money and pain spent and I fell ripped off by the amount of mental and physical energy and time I spent of the case.  It's just a lose-lose.

In the case of the above sweet patient 2000 miles away, I am not just sure I can do all that is necessary to properly evaluate her and figure out her real expectations and provide her with a good surgical experience.  This particular case my end up working out with a lot of work on my end and hers.  If it does, I'll let you know.
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Seattle Plastic Surgeon