Medical Malpractice and Patient Contributory Negligence in Breast Reduction Surgery

According to the Tribunale Ordinario di Latina in a ruling issued on August 19, 2025, a health facility shares liability for a patient’s post-surgical necrosis following a televised reduction mammaplasty, though damages were reduced due to the patient’s smoking. The Second Civil Section of the court partially upheld the patient’s claim for compensation, addressing medical malpractice standards and the application of the Gelli-Bianco Law.

The legal proceedings stem from a reduction mammaplasty performed in November 2017 during a television program focusing on cosmetic surgery and make-over journeys, as reported by the court. During the post-operative recovery, the patient developed a severe complication in the areolar region of the right breast. This condition progressed to areolar necrosis, which required the plastic surgeon to perform a surgical wound revision.

Following the complication, the patient filed a lawsuit against both the operating physician and the healthcare facility, alongside their respective insurance companies. The plaintiff sought full compensation for both economic and non-economic damages. The legal complaint alleged a failure to properly obtain informed consent and improper execution of the surgical technique, according to the tribunal records.

Tribunal Applies Gelli-Bianco Framework to Separate Facility and Physician Liability

The court evaluated the case under the legal framework established by Law No. 24 of March 8, 2017, known as the Gelli-Bianco Law. Under Article 7 of this legislation, the tribunal applied a strict bifurcation of civil liability between the healthcare entity and the individual practitioner.

The healthcare facility’s liability remains contractual under Articles 1218 and 1228 of the Civil Code, meaning the institution answers to the patient based on hospital contract obligations with a ten-year prescription period and a shifting burden of proof. Conversely, the physician’s liability is classified as extra-contractual or aquilian under Article 2043 of the Civil Code, because no direct contract was established between the doctor and the patient in this specific instance.

Surgeon Cleared Due to Lack of Proof on Subjective Fault

Applying these evidentiary rules, the judge dismissed the claims brought directly against the operating physician. While the plaintiff established the material causal link through a medical-legal expert report regarding the onset of areolar necrosis, the court found the plaintiff failed to allege or prove the subjective element and degree of the physician’s fault.

Under the Gelli-Bianco statute, proving the subjective element is mandatory to establish aquilian liability for a healthcare provider and to justify any internal right of recourse by a facility against a doctor. Because this burden was not met regarding the surgeon’s subjective conduct, the claim against the doctor was rejected.

Facility Held Accountable for Iatrogenic Complication

In contrast, the tribunal held the healthcare facility accountable under contractual terms. Medical-legal technical expert evaluations confirmed that the temporary and permanent psychophysical injuries derived causally from the surgical treatment, classifying the outcome as an iatrogenic complication tied to the nature of the procedure.

However, the court adjusted the final compensation awarded to the patient. The tribunal factored in a contributory fault by the claimant under Article 1227 of the Civil Code, noting that the patient violated the established smoking ban during the recovery period, which directly contributed to the adverse healing outcome and the severity of the necrosis.