More than 30 malpractice claims raise questions about this surgeon’s decisions
Industry Buzz
I felt that this provider was causing harm—practicing out of scope of her training. These patients have had legitimate complaints and concerns.
—Steven Montante, MD
A growing series of malpractice allegations against a Virginia breast surgeon is now prompting regulatory scrutiny, raising broader concerns about scope of practice, informed consent, and oversight in breast reconstruction care. []
The Virginia Board of Medicine is considering disciplinary action against Sasa Grae Espino, MD, following multiple patient complaints related to her surgical care. []
The board’s review centers on at least two patients, but more than 30 women have filed malpractice lawsuits alleging harm. []
Related: Massachusetts rheumatologist accused of assaulting over a dozen patientsAllegations center on scope of practice and surgical decision-making
Across complaints and lawsuits, a consistent set of concerns has emerged:[]
Procedures beyond training: Multiple complaints allege Dr. Espino performed complex breast reconstruction operations despite not being a board-certified plastic and reconstructive surgeon.
Deviation from standard of care: Reviewing surgeons described one patient’s outcome as “severe deformity” and “not consistent with the standard of care.”
Questionable indications for surgery: In at least one case, a patient underwent risk-reducing mastectomy that a subsequent surgeon said would not have been recommended; surveillance imaging and medical therapy were cited as appropriate alternatives.
Inadequate follow-up: Another reviewing physician stated appropriate postoperative follow-up was not arranged.
Parallel lawsuits expand on these themes, alleging unnecessary mastectomies, failure to recognize complications such as infection or wound breakdown, and performance of procedures outside the surgeon’s scope.
"I felt that this provider was causing harm—practicing out of scope of her training. These patients have had legitimate complaints and concerns," said Steven Montante, MD, a plastic surgeon in Virginia who had filed past complaints about Dr. Espino. []
The takeaway for physicians
This case exposes recurring failure points that are clinically relevant across oncology, surgery, and primary care.
What to watch for in your practice:
Indication clarity for mastectomy. Ensure patients understand absolute vs relative risk reduction and document guideline-based rationale.
Scope-of-practice transparency. Clarify whether reconstruction will be performed by a board-certified plastic surgeon vs an oncoplastic breast surgeon and encourage multidisciplinary planning for complex reconstruction
Second opinions for irreversible surgery. Consider recommending a second opinion before risk-reducing bilateral mastectomy, especially in non-mutation carriers
Postoperative surveillance and escalation pathways. Educate patients on early signs of complications such as increasing symmetry, persistent drainage or swelling, delayed wound healing, and signs of infection.
Informed consent quality. Verify patients understand non-surgical alternatives, expected outcomes, and complication risks
What to tell patients considering breast surgery
Patients considering breast surgery—particularly prophylactic or reconstructive procedures—should be advised to:
Ask whether their surgeon is board-certified in plastic and reconstructive surgery if reconstruction is planned
Request quantitative cancer risk estimates and guideline-based recommendations
Seek a second opinion before irreversible procedures
Understand that more aggressive surgery does not always confer better outcomes