We thank Charles E. Rawlings, attorney for the plaintiff, for sending us a report of this case. The plaintiff, age thirty-three, had significantly large breasts which caused neck, shoulder and back discomfort. The plaintiff was a smoker who had been treated multiple times at an out-patient clinic for treatment of her tobacco use. In January 2008 the plaintiff went to a VA center and consulted Dr. Frank Lansden regarding a breast reduction. Dr. Lansden found the plaintiff to be a good candidate for the surgery and found no contraindications for the procedure. Bilateral breast reductions were performed in late March 2008 by Dr. Lansden. Dr. Lansden did not note or heed the plaintiff's history of smoking until the day of surgery. Dr. Lansden noted on the day of surgery that the plaintiff's smoking could cause significant problems with wound healing. Dr. Lansden, however, proceeded with the surgery. Dr. Lansden claimed that the plaintiff was advised of the risks associated with smoking prior to the procedure, but claimed that he would advise a patient to stop smoking prior to such a procedure, but would never tell a patient to stop smoking. After surgery the plaintiff noted that her right nipple was dusky in the hospital, but she was discharged. On the third postoperative day the plaintiff went to another VA facility complaining of her right nipple and areola turning black. While at the other facility the plaintiff called and spoke with Dr. Landsden's physician assistant, who relayed that nothing could be done and that she was to keep her regular appointment. Over the next several weeks, the plaintiff’s breasts, nipples and areolae began to develop necrosis until her breasts lost significant amounts of tissue and both her right nipple and areola were lost. The plaintiff underwent debridement surgery for the necrosis. The plaintiff’s breasts are now of unequal size, misshapen and deformed despite multiple reconstructive surgeries. The defendant maintained that contributory negligence for the plaintiff’s smoking barred any recovery. All of the plaintiff’s care was provided through the Veteran’s Administration system, resulting in no significant medical expenses. The plaintiff also suffered no significant lost wages. A $125,000 settlement was reached during mediation. Plaintiff's Expert: Hubert Weinberg, M.D., plastic surgery, New York, NY. Defendant's Expert: Gregory Georgaide, M .D., plastic surgery, Durham, NC . Jane Doe v. U.S.A., U.S. District Court, Western District of North Carolina, Case No. ____. Charles E. Rawlings, The Rawlings Law Firm, Winston-Salem, NC for the plaintiff. Sid Alexander for the defendant.