Ms Y, a 31-year-old youth worker, went to a private clinic to discuss cosmetic breast surgery. After a brief consultation with Dr E, a cosmetic surgery specialist, she agreed to undergo bilateral breast augmentation with silicone implants.
Three weeks after the surgery, Ms Y telephoned the clinic as fluid was seeping from the scar on her left side. A week later, she saw Dr E, who dressed the wound and took a swab for culture, which showed no growth.
Two weeks later, Ms Y saw Dr E again. By this time a 1cm section of the scar had opened up. Dr E arranged to see her again in three weeks. However, Ms Y’s wound underwent further dehiscence. She spoke to the clinic and was advised to wash the wound with salt water. She attended the next week, when the wound had a gap of at least two inches within it. No surgical staff were available to see her. Shortly after this the prosthesis began to protrude through the open wound.
Two months after the original surgery, Dr E operated to remove the implant. Three weeks later he inserted a new implant. The revised scar healed poorly and opened up again. The implant had to be removed once more. Ms Y needed reconstructive surgery at another institute, which was paid for by the clinic Ms Y originally consulted.
Ms Y sued Dr E and the clinic, alleging that she had not been properly advised about the effects and possible complications of the procedure; that the implant should have been removed much earlier once the wound started to open; and that her subsequent operations and care were negligent.
Ms Y alleged that she now suffered marked psychological distress. An independent psychiatrist whom Ms Y had consulted before and after her operation confirmed the severe and disabling nature of the symptoms Ms Y now had to endure as a result of her surgical experience and its effect on her body image.
A plastic surgery expert was critical of Dr E’s management. In his opinion, once the breast augmentation scar started to discharge significantly it was a matter of ‘great surgical importance’ that the patient be seen within 24 hours and kept under close supervision.
The expert considered the decision to remove the implant correct, but excessively tardy, and that the re-insertion of the implant should have been left for at least 3-6 months. Because of this, the expert felt that the re-augmentation procedure was ‘doomed to failure’.
We could not defend the claim and agreed to pay 75% of the settlement to Ms Y, the remainder being met by the private clinic. Ms Y received a sum equivalent to £60,000 and costs of nearly a third of that amount.
Standards of aftercare
Make sure that the institutions you work with have sufficient resources and are well enough organised to provide your patients with a satisfactory level of care. Ensure that you are contactable and available to deal with any adverse outcomes, particularly when working in the private sector, where the absence of junior colleagues may mean that you are the only source of help for patients who are not doing well.
Consult your national professional association of cosmetic or aesthetic surgery if you are uncertain what their recommendations/guidelines are for private practice.
Extruded breast implants – See the following recently published papers on the management of this complication of augmentation mammoplasty:
Spear SL et al., The Infected or Exposed Breast Implant: Management and Treatment Strategies, Plast Reconstr Surg 113(6): 1634–44 (2004).
Fodor L et al., Fate of Exposed Breast Implants in Augmentation Mammoplasty, Ann Plast Surg 50(5): 447–9 (2003).