Case settled after surgeon fails to obtain consent for positioning of breast implants

We have settled a claim against a plastic surgeon who failed to obtain adequate consent from our client regarding the placement of her breast implants. Breast augmentation surgery involves the creation of a pocket that allows for the breast implant to be placed above or below the chest muscle. The pocket can be made in one of two places: either under the breast itself, known as sub-glandular or sub-mammary; or under both the breast and chest muscle, known as sub-muscular or sub-pectoral placement.

During the consultation process, the surgeon should examine the patient and explain the advantages and disadvantages of each breast pocket placement, so that the patient can decide which she feels will give her the result she is looking for. There is no single approach to implant placement that is ideal for every woman and the factors to consider include how much breast hang the patient has (knows as ptosis or sagging), how much natural breast tissue she has and whether her breast tissue needs repositioning relative to her chest muscle. The placement and technique the surgeon uses should be selected based on the individual patient’s choice after she has been fully informed, as well as taking into account her existing anatomy and desired goals.

In this case, our client consulted the defendant, a private plastic surgeon, as she wished to undergo breast augmentation to regain a natural shape after breastfeeding her children. She was very clear in expressing her desire to achieve a natural look and that she was not looking for a ‘celebrity wide-look’. In her own words, her desire for surgery was to look shapely again in clothes, and not about looking good naked. The defendant said he understood and recommended sub-muscular placement to reduce the visibility of the implants. He did not explain to our client the risk of sub-muscular placement pushing the implants out laterally, which might result in a ‘wide-look’. Surgery went ahead and regrettably, the implants were positioned laterally to the extent that our client was unable to move around comfortably with her arms down by her sides, due to the implants sitting almost underneath her armpits. She also could not be fitted for a bra.

The defendant surgeon agreed to revision surgery, stating that he would rectify the positioning by sewing up the sides of the implant pockets so the implants sat more centrally on our client’s chest. He did so, but just a week after surgery the pockets gave way and the implants slid back to their initial lateral position, leaving our client distraught.

Ultimately our client consulted another plastic surgeon for a second opinion, and underwent surgery with him, her third operation, to have the implants removed and repositioned in a sub-mammary position. This was successful and she was delighted with the results, but was disappointed that she had required three operations to reach this stage.

Had our client been advised properly of the advantages and disadvantages of each option by the defendant surgeon at the outset, she would have been made aware that sub-muscular positioning can lead to more lateral implant positioning and would have wanted to avoid this. She would therefore have opted for sub-mammary positioning in the first place and would have been likely to obtain a good result with just one operation.

The defendant surgeon denied liability but was willing to consider settlement, which was achieved without needing to litigate. Alison Johnson, an associate director in our clinical negligence team, who has significant experience of handling cosmetic surgery claims, led the team representing our client.

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