(Filed January 17, 2017)
This is a cosmetic surgical malpractice case filed by a woman in Baltimore City following breast reduction surgery. It was filed in Health Claims Arbitration on January 17, 2017, and is the 21st case filed in 2017 in Maryland.
- Another breast reduction malpractice case filed in Cumberland, Maryland
Plaintiff consults defendant doctor for breast reduction surgery due to significant back, neck, and shoulder pain. Defendant doctor agrees that plaintiff is an appropriate candidate for surgery. Plaintiff undergoes surgery at St. Agnes Hospital.
Plaintiff alleges that during the procedure, defendant doctor fails to ensure that there is an adequate blood supply to both breasts. After the surgery, during a follow-up appointment, defendant doctor notes that plaintiff has significant edema. He prescribes Silvadene (a sulfa cream) dressings, despite plaintiff's noted sulfa allergy.
A month later, when plaintiff goes in for her appointment, defendant doctor finds significant bilateral wound ruptures that had worsened and serious drainage, necrotic skin, and a worsening wound on plaintiff's right breast. Despite this finding, he does not culture the wound or prescribe antibiotics. He does schedule a debridement procedure and placement of a wound VAC.
After the debridement, plaintiff goes back to defendant doctor with significant drainage, fever, and chills. Defendant doctor finds skin necrosis with considerable necrotic tissue. He documents changes in the wounds such as foul-smelling odors. Despite this, he does not prescribe antibiotics or culture the wound to test for infection. He schedules another debridement procedure that plaintiff undergoes.
After the second debridement, plaintiff returns to the office but sees defendant's partner, as defendant doctor is on vacation. This doctor finds that plaintiff was suffering necrosis and a loss of both nipples. Defendant doctor conducts another debridement and skin graft procedure, during which she loses a majority of her breast tissue. She is left with significant scarring and deformities of both breasts.Additional Comments
- Plastic surgery medical malpractice cases in Maryland are extremely difficult.
- It is a huge help for plaintiffs that they were able to find a plastic surgeon in Maryland to testify. It is hard to find a local doctor in a specialty to testify against another local doctor in that same specialty.
- There are not a lot of details in this Complaint that gives us a clear picture of what happened here. The cause of nipple necrosis is usually an inadequate blood supply. Poor blood supply can result from poor technique when removing the surface skin and deeper skin, which is done in most breast reductions. Another surgical technique issue is suturing the tissue too tightly, improper placement of dressings, poor or sloppy folding of the nipple upon itself when closing up after the surgery.
- Nipple necrosis is a relatively rare event. The risk of nipple necrosis increases with the amount of breast tissue being removed.
- As a starting point, a doctor needs to perform an accurate preoperative assessment assess the vascular supply to the breast using laser Doppler and angiography studies before surgery to ascertain the best surgical approach. The results of this testing might inform the type of procedure performed. For example, the inferior pedicle technique had a higher rate of reliability as far as blood supply then the superior pedicle technique.
- The standard of care in inferior pedicle reduction requires the surgeon to insert drains to avoid collection of blood and fluids after the procedure. Failure to place drains and reduce the amount of skin excision can cause the vascular compromise of the skin and the accumulation of blood.
- This case was filed ten days before the three-year anniversary of the surgery. If any preoperative assessment was done before that date, that negligence should not be considered.
- The standard of care requires the surgeon to perform a postoperative assessment. The big thing is devascularization. The surgeon must determine the efficiency of drain placement and change the operative dressing to identify any tissue necrosis. This might require the use of a hyperbaric oxygen chamber, ice, or steroids. If there is an issue, the doctor may have to go back in to check the breast for a hematoma.
- Many breast reduction malpractice cases involve allegations that the surgeon failed to adequately estimate the amount of tissue to be removed. Usually, the problem is that too much tissue is removed. There is something called the Schnur Sliding Scale Chart that doctors can use to determine the minimum estimated specimen weight of breast tissue that the surgeon would be expected to remove from each breast. The amount of breast tissue removed is too high it is difficult to achieve a cosmetically acceptable result.
- Hopefully, this woman can make a meaningful recovery that result in a good cosmetic result. It will take some work and pain. She will likely need an additional surgical procedure to remove the dead tissue. She will probably also need a follow-up surgery to reconstruct the defect. The results will vary from patient to patient.
- Baltimore City
- St. Agnes Healthcare, Inc.
- The Maryland Institute of Plastic Surgery
- A plastic surgeon
- St. Agnes
- Failure to ensure adequate blood supply during breast reduction surgery
- Failure to timely culture plaintiff's wounds
- Failure to timely order antibiotics
- Failure to recognize signs and symptoms of infection
- Failure to treat plaintiff's infection
- Medical Negligence
- Informed Consent
- Loss of Consortium
- Barry Cohen, M.D. - plastic and reconstructive surgeon
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