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"On behalf of [litigant] I wanted to express our sincere thanks for working with us on this case. Your candid assessment of the case allowed for a favorable resolution. Thank you very much for all of your work and the professional guidance you gave me." — Attorney Client

Case Descriptions

OPERATIVE COMPLICATIONS

46 year old female with a family history of breast cancer presented with a mass on self breast exam. Conventional imaging with mammography and ultrasound showed fibrocystic change. A defined mass on exam was confirmed by surgeon and an excisional biopsy via a circumareolar incision was performed for diagnosis. Postoperatively patient developed a hematoma requiring return to the operating room. Subsequently, she developed a wound infection, and abscess under the nipple and areola. Ultimately the patient had wound breakdown and skin necrosis with loss of the nipple and areolar complex.  Issue at hand was whether surgery resulted in loss of the nipple and areolar complex.

RISK ASSESSMENT

43 year old female presented to surgeon after genetics consultation revealing patient to be at high risk for breast cancer using the Tyrer-Cuzick model. Patient elected bilateral prophylactic mastectomies and tissue expander insertion by plastic surgery. Postoperatively, she developed an unusual mycobacterium infection resulting in loss of the reconstruction and prolonged IV antibiotic usage. Issue was to determine appropriateness of risk assessment model for prophylactic surgery.

BREAST CANCER SURGERY STANDARDS

49 year old female presented with an image detected left breast cancer. Seen by surgical oncologist at cancer center. Patient returned to her primary provider, an obstetrician/ gynecologist. Gynecologist performed a lumpectomy and "axillary sampling." Two additional breast surgeries required for clear margins and sentinel node biopsy was advised for appropriate oncologic staging. Patient developed lymphedema of the breast. Issue to determine was whether, if her initial surgery had been performed by a surgeon with appropriate breast cancer surgery training, her lymphedema symptoms would have been avoided.

DELAY IN DIAGNOSIS

38 year old female with strong family history of breast cancer presented complaining of a breast lump. Exam with ob/gyn felt to be "benign fibrocystic change." Patient presented one year later with locally advanced breast cancer requiring mastectomy, chemotherapy and radiation. Asked to review for possible missed diagnosis of cancer.