Background: bilateral breast reduction mammoplasty is a popular cosmetic surgical operation. Patients usually aim to bring down the volume of the breast to achieve har-monious to their build along with overcoming the inconvenience caused by enormous, ill-shaped and suspended breasts. As the aesthetic appearance performs major im-portance in this procedure, a minimum of scar load is usually predicted, and the tech-nique used must be individualized. However, preserving sensation and breastfeeding, especially during the child-bearing period, are also crucial. Complications are to be predicted in reduction mammoplasty; however, various post-operative complications were recorded because of errors of judgement, faulty surgical plan, and imprecise im-plementation of the plan. While plastic surgeons experience one of the highest per-centages of physicians facing a malpractice claim, the unexpected cosmetic result pre-sents the evident complaint. Objective and method: discussion of a case of a medical malpractice claim of post-operative bilateral necrosis resulted in total excision of the nipple-areola complex (NAC) along with the underlying tissue in both breasts. Medi-cal and operative history details of the patient were discussed against the surgical pro-cedure and the surgeon's decision. The result is to understand the reason behind the catastrophic result and the management of the medicolegal claim to reach the prove of the medical litigation due to faulty surgical decision and management. Conclusion: most complications can be avoided with proper history taking, selection of the appro-priate operation for the given patient and proper post-operative complications han-dling.