Call us today at 281-580-8800 or email us at

Plastic and cosmetic surgeons must consider breast width and other factors before proceeding with breast augmentation surgery Contact Now

Plastic surgeon uses over-sized breast implant, causes permanent nerve injury

Plastic and cosmetic surgeons must consider breast width and other factors before proceeding with breast augmentation surgery

As a Houston, Texas medical malpractice attorney, I have handled numerous cases involving serious injuries or deaths caused by the negligence of a plastic surgeon or cosmetic surgeon.

Of course, the most tragic outcome from any plastic or cosmetic surgery is a patient death. In my experience, this most often occurs because of post-operative care. One such case comes to mind.

Patient deaths after plastic/cosmetic surgery

I successfully handled a Dallas case where a middle-aged woman went to an outpatient ambulatory surgery center for some elective cosmetic surgery procedures. She was under general anesthesia and immobile in the operating room for nearly 10 hours and developed blood clots in the deep veins of her legs.

The cosmetic surgeon kept her in the surgery center overnight and discharged her the next day without stopping by her room to see her. The surgeon did not prescribe a simple medication that would have prevented blood clots from forming and spreading to her lungs as a pulmonary embolism. A pulmonary embolism forms when a blood clot breaks loose and blocks an artery in a lung.

This mistake was of great concern to our surgical expert witness, who explained that the total length of her surgery plus the types of procedures she had done placed her at an increased risk for clot formation.  Within a few days of discharge, she tragically died from a pulmonary embolism.

The major professional associations for plastic and cosmetic surgeons have refused to adopt standards and guidelines to surgeons use best practices in the operating room and beyond. In my opinion, this inaction was deliberate, to avoid having written standards that could potentially be used to hold plastic or cosmetic surgeons responsible for malpractice. By the way, the professional associations for neurosurgeons, spine surgeons, and orthopedic surgeons, have such standards, including for post-operative orders for prophylaxis medications to prevent clot formation.

Taking elective procedures too far

Another type of cosmetic or plastic surgery malpractice involves using an incorrect or overly-aggressive surgical technique in the operating room. I am working on a case now where I believe this is what happened.

My client is a woman in her 30's who to have her existing implants removed and replaced with larger ones. She went to see a plastic surgeon in The Woodlands, who recommended a huge implant size. According to our plastic surgery expert, this was the first mistake.

When a plastic or cosmetic surgeon is planning a breast augmentation procedure, the standard of care requires consideration of the patient’s breast width in an order to select the maximum safe size for a breast implant.

Width is the key dimension for properly fitting breast implants to the body. Surgeons should measure and document the patient’s breast with in centimeters, measured in a straight line from the outer edge of the breast next to the arm to the inner edge the breast to the point where the cleavage meets.

The standard of care also requires cosmetic or plastic surgeons to recommend an implant that is slightly narrower or the same width as the patient’s current breast width. In other words, if the patient’s breast measures 12 cm wide, then implant with a diameter of 12 cm or slightly less would be a good fit. Most competent plastic and cosmetic surgeons recommend implants that are narrower than the patient’s current breast width.

Beyond breast width, the standard of care requires plastic or cosmetic surgeons to perform and document additional measurements, including breast height, rib cage width, shoulder width, weight, and height.

I think that these standards make it clear that patient safety should be a primary consideration in plaster or cosmetic surgery. While patients may have a certain outcome in mind, it is up to the surgeon to provide appropriate counseling as to what is safe and possible, and to document a proper physical exam with all the necessary measurements to back up decision-making.

In the case that I am currently investigating, the plastic surgeon took my client to surgery at Houston Northwest Medical Center, removed the old implants and replaced them with new ones over double their size. In fact, the implants that he selected for the patient are the largest ones produced by the manufacturer, even though her breast width was far too narrow to accommodate them, according to manufacturer’s recommendations.

My client’s first post-operative visit with the plastic surgeon was a week after the surgery. The patient was already complaining of discomfort in the side of her left breast. As the weeks turned into months, her pain got worse and worse. She now suffers from constant severe throbbing, burning, and shooting pain from her left nipple and surgical scar. Just to cope with the pain and try to get on with her daily living, she has to apply constant pressure on her left breast.

She is seen multiple physicians to try to get relief, to no avail. The consensus is that she will live with this pain for the rest of her life because she probably has nerve injury.

That is precisely the conclusion of the plastic surgery expert that we retained review the medical records. The expert believes that the plastic surgeon’s decision to use such a huge implant—much wider than the patient’s breast width—caused permanent injury to the patient’s intercostal nerves. This is the source of her constant pain.

It is easy to understand why the safety standards are in place concerning implant size. If a surgeon tries to jam an implant too large to fit into a space that is too small, nerves and other structures may can get injured in the process.

We are here to help

If you or a loved one has been seriously injured or even died because of poor medical, surgical, or hospital care, then the experienced medical malpractice attorneys at Painter Law Firm, in Houston, Texas, are here to help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.

All consultations are free and, because we only represent clients on a contingency fee, you will owe us nothing unless we win your case. We handle cases in the Houston area and all over Texas. We are currently working on medical malpractice lawsuits in Houston, The Woodlands, Sugar Land, Conroe, Dallas, Austin, San Antonio, Corpus Christi, Bryan/College Station, and Waco.


Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. A member of the board of directors of the Houston Bar Association, he was honored, in 2017, by H Texas as one of Houston’s top lawyers. In May 2018, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him by calling 281-580-8800 or emailing him right now.

// Read full biography
// Read more expertise by Robert Painter

Discover More