Plastic surgeons demonstrate the meaning of the original Greek “plastikos” (to mold or form) every time they surgically reconstruct or enhance a patient’s face or other body tissues caused by birth defects, illness, tumors, infection, or traumatic injuries. Whether it is a life-changing reconstructive procedure after breast mastectomy, or repairing a cleft palate, removing a disfiguring birthmark, or improving appearance with a cosmetic facelift or Brazilian Butt Lift, these specialty procedures carry a high risk of possible complications that trigger malpractice claims.

According to the Medscape Surgeon Malpractice Report 2021, general and plastic surgeons are ranked number one on the list of top 10 medical specialists most likely to be sued for malpractice, most commonly due to surgical complications. That’s why plastic surgeons require robust medical malpractice coverage from an AM Best “A” rated carrier with a strong track record of defending their policyholders.

However, as a plastic surgeon, you can also take proactive steps to better manage your malpractice risk while improving the quality of patient care and outcomes in the process. This article explores findings from recent studies of plastic surgery malpractice claims to help you understand, identify, and potentially lower the risk factors for your specialty.

Plastic surgery risks and most common malpractice allegations

A recent review of malpractice cases by “A” rated malpractice insurance carrier MedPro Group found that three areas in particular – improper performance of surgery, improper management of the surgical patient, and improper performance of medical procedure – added up to over 80% of the allegations leading to malpractice claims and payouts to plaintiffs.

Improper surgical/procedure performance

The surgeon’s lack of technical skill or experience in surgeries (91% of cases) and procedures (97% of cases) was the highest contributing factor in performance allegations.

  • 47% of claims for improper performance of surgery were triggered by the following complications: the need for additional surgery, scarring, cosmetic injury or deformity, and infection.

  • 13% of claims for improper procedure performance involved skin excisions, dermabrasions, chemical peels, injections, and tattoo removal.

  • Iatrogenic patient injury during breast-related surgical procedures was the most frequent malpractice allegation, followed by: Skin or tissue size reduction, Eyelid-related procedures, Rhinoplasty/septoplasty, “Facelift”

  • The majority of the cases had allegations of medium or temporary, non-disabling clinical severity, such as: burns, medication side effects, delayed recovery, loss of fingers, organ damage, and infection. Only 10% of the cases in the study had allegations of high or permanent clinical severity, or death.

Additional data on breast-related malpractice allegations from a study of plastic surgery cases by The Doctors Company Group (TDCG), an AM Best “A” rated carrier, further supports the need for strong malpractice insurance coverage and a strategic risk management plan:

  • Breast reduction (21.8%), breast augmentation (17.2%), and breast reconstruction (11.8%) were the top three types of procedures most often named in plastic surgery claims.

  • The need for additional surgery was the most common allegation in breast reconstruction claims. (52.7%).

  • 86% of the plastic surgery claims had the following contributing factors to malpractice allegations: selection of procedure or therapy, poor surgical technique, and known complications.

Patient management and poor clinical judgment

The MedPro study noted that malpractice claims related to improper management of surgical patient were more complex to defend that those citing improper procedures. On average, they were significantly more expensive to resolve than other cases in the study.

  • Allegations of poor clinical judgment ranked highest in 90% of the cases involving improper management of surgical patient.

  • Poor communication with the patient and failure to manage patient expectations resulted in allegations of patient dissatisfaction with surgical outcomes, and complications due to not adhering to post-surgical follow-up and treatment plans.

  • 21% of cases alleging improper patient management cited the surgeon’s poor judgment and lack of a timely response to developing complications before, during, and/or after surgery.

Establish a proactive risk management strategy

Now that you’re more familiar with some of the most common malpractice allegations in plastic surgery cases, how can you potentially reduce your risk? The following recommendations based on findings in the MedPro study provide a good starting point for effective risk management strategies for plastic surgeons:

  • Stay up to date with current and emerging plastic surgery skills and techniques, especially for breast-related procedures which result in allegations of improper surgical procedure most often.

  • Improve patient communication. Ensure that patients give informed consent and understand the various procedures and risks of the specific type of plastic surgery they will undergo.

  • Confirm that the patient is a good candidate for the surgery. Ensure that the patient’s post-operative assessment documents any patient comorbidities that could put them at greater risk for complications, including:

    • Smoking
    • Obesity
    • Connective-tissue damage
    • Poor circulation at surgical site
    • Impaired immune system
    • Poor nutritional habits
  • Improve detection of complications and response time. Emphasize to patients the critical importance of following post-surgical instructions to prevent infection and other common complications. Ensure that patients recognize the following signs of serious complications and know to call you and seek immediate care:

    • Blood-soaked bandages and wound dressings (excessive bleeding)
    • Yellowish discharge at incision site (infection)
    • Pain not relieved by medication
    • Abnormal swelling in groin or lower leg (blood clots)
    • Vomiting and inability to keep down fluids
  • Lastly, keep highly detailed documentation of all physician/patient interactions, diagnostic test orders and results, pre-operative assessments, intra-operative steps, and the sequence of post-operative events. If you are sued for malpractice, having complete case documentation will help your lawyers build a stronger case.

Need Medical Malpractice Insurance for Your Plastic Surgery Practice? SURGPLI can Help.

Our experienced SURGPLI insurance brokers save plastic surgeons time and effort by researching and recommending your best options for malpractice insurance coverage, rates, and carrier. Get a fast quote or call 1-800-969-1339

SURGPLI is a division of MEDPLI, an independent insurance brokerage that specializes in making medical malpractice insurance simple for doctors.

Max Schloemann

About the Author

Max Schloemann is a medical malpractice insurance broker, focused on helping physicians secure Medical Professional Liability coverage. He helps Doctors and Surgeons, as well as Physician Assistants, Nurse Practitioners, and healthcare entrepreneurs launch new medical practices across the country. Max graduated Magna cum Laude from Southern Illinois University College of Business and was named the Outstanding Management Senior. Max’s career in medical malpractice insurance began in 2008 with an industry-leading firm. Max founded SURGPLI in 2023 to help surgeons navigate the complexities of medical malpractice insurance in the new era of healthcare. Max’s wife, Kristen, a Physician Assistant, and their 4 kids (plus 1 dog) enjoy hiking, golf, and cooking.

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