Hey there! You have good options in the PNW. If you're using insurance, the insurance company will require letters, so finding a surgeon who does informed consent would be moot. If you don't use insurance, then both Dr. Sajan and Dr. Mangubat in Seattle do informed consent. Dr. Mangubat has the most experience in the area, he trained Dr. Sajan, but both get great reviews from patients. AFAIK, all the surgeons in Oregon require letters. Dr. Garramone does very nice work, but that would be a lot of travel and you have just as qualified surgeons in WA. I traveled 6 hours away for Top Surgery and found it rough. To be able to be in my own bed after surgery... That would have been nice. I hope this helps!
Joshua