This case involves a middle-aged woman who presented to a medical spa in order to undergo breast augmentation surgery. A few days After the procedure, the woman noted significant drooping in both breasts, as well as a small area of inflamed tissue near her surgical wounds. The patient returned to the operating physician, who gave her antibiotics and debrided her wounds. Over the next few days, the Plaintiff’s condition continued to deteriorate, and the treating physician attempted a second surgery to implant fat in the woman’s breasts to counteract the drooping. However, this repair went poorly, and the woman continues to suffer disfigurement from the procedure.
Question(s) For Expert Witness
- 1. Do you routinely treat patients similar to the one described in the case? What is the standard workup when presented with a patient with complaints of ptosis of the breasts?
- 2. Please discuss your background in performing this type of procedure. Based on the brief case summary, can you determine if she was a good candidate for the procedure? Have you ever had a patient develop the outcome described in the case?
Expert Witness Response E-001709
The standard work up for patients presenting with complaints of ptosis of the breast is as follows: Measurement of ptosis, digital photography, assessment of skin envelope, history of breast disease/imaging/cancer/other lesions, medical history, smoking history. Goals in terms of nipple position, volume, scar location, type of implant versus autologous fat. Fat grafting for correction of ptosis is a relatively new technique for correction of breast contour and shape deformities. It is impossible without photos to know for sure but typically a mastopexy of some type is more commonly used in this application. Risks like fat necrosis, altered mammography, incomplete graft take, and possible injury to implant or need for revision should be discussed. I have never had them develop this outcome where the breast needed to be debrided. I believe that it is very likely that this patient could have has a better outcome if the care rendered had been different.
This board certified plastic surgeon, practicing for more than 10 years, focuses on all areas of plastic surgery including breast surgery, other forms of aesthetic surgery, reconstruction surgery, and hand surgery. Fellowship trained at Washington University School of Medicine in St. Louis, he is an Associate Professor of Plastic and Reconstructive Surgery at a top university medical center in Missouri and is currently the President of the St. Louis Area Plastic Surgeons. He is the author of over 60 peer-reviewed research articles, textbook chapters, and has been a featured presenter at national and international plastic surgical and medical conferences.
Expert Witness Response E-000629
I perform between 100-200 breast augmentations annually. I am a consultant to a major breast implant manufacturer and lecture on breast augmentation to other plastic surgeons as well as industry. I am a consultant to a company that produces 3D imaging and computer simulation for breast augmentation. I treat patients like this commonly. Standard workup includes physical examination, mammogram if indicated and assessment of tissue dynamics. I also do 3D imaging and computer simulation although that is above standard of care. Patients with ptosis frequently require a mastopexy- all patients with grade III ptosis will require it. Fat grafting alone is not indicated in this case. I have never had seen this complication in my own patients- it is probably due to infection and possibly incorrect performance of the procedure.
This highly qualified hand surgeon completed a residency in General Surgery at the University of Cincinnati Medical Center and subsequently completed Fellowships at some of the most highly regarded medical centers in the country. He is considered an authority in Hand Surgery and regularly presents and lectures on the topic. He is a member of the American Society for Surgery of the Hand and maintains a busy clinical practice.