I remember the first time it happened. The teenage girl had come to the Plastic surgery clinic when I was a new plastic surgery resident. She had one breast that had not developed. She was wearing baggy clothes and kept her head down with her hair covering her face. Her mother did all the talking. We discussed a surgical plan and took her to operating room. Afterwards when she came for her postoperative visit the change was nothing short of miraculous. Not the surgical results although that had turned out well but the overall change in her appearance and even attitude. She was wearing clothes that fit, her hair was pulled back and best of all she would not stop talking! She even left her mother outside when she came into the exam room for her postoperative exam. `I was again reminded of this girl when a similar situation happened. Again it was a young girl and her mother. No one could explain why she had failed to develop on one side of her breasts but worse yet, no one had offered any solutions. It had even been suggested that she might have to wait to get anything corrective done until she was an adult. I was able to diagnose her and offer surgery that would give her symmetry throughout her development with a final surgery to be done when she was fully grown. The look of relief and gratitude on both the mother and daughters faces was overwhelming. The day had been long before with problems with obtaining authorizations from insurance companies, scheduling problems, lost dictations and all the other myriad of problems that make up a typical day in a medical office. I had recently received notice from my medical school that a big reunion year was approaching. A questionnaire had been sent out to all of the alums. One of the questions asked was “If you had it to do over again would you choose a career in medicine?” Quite a few had responded that they would not , citing the increasing pressures on physicians with decreasing reimbursements and increasing paperwork as the reasons. If I had been asked that question earlier that day while in the middle of a particularly frustrating fight with an insurance company I might have been tempted to answer “No” . Fortunately most of my time is spend in the actual care of patients and just when you get frustrated enough a patient comes along like that young girl who reminds you of what plastic surgery is all about. Too often especially in Hollywood the perception of plastic surgery is one of a purely cosmetic field. Cosmetic surgery is the improvement on the normal, reconstructive surgery is the restoration to the normal. Plastic Surgery encompasses both, often with the same techniques used to achieve the different goals. It is too easy to get swept along in the business side of keeping a practice going and forget what the real goals of the day are and most importantly why I became a plastic surgeon. I have the privilege of being able to travel with Interplast and offer my skills to help the very poor of the world correcting cleft lips and palates or undoing the damage done by burns. On my last trip to Ecuador in December a burn victim brought us her finest chickens to thank us for what we had done for her. No thanks were necessary. I had received much more from her than she had from me. My husband calls these mission trips my “psychic income”- a term he learned from a business professor in college. Medicine and in my opinion especially plastic surgery, is a wonderful career and fortunately these patient interactions occur often enough to remind me of how lucky I am to have chosen this profession.