For some patients, waking from surgery to discover they’ve had an extra plastic surgery procedure they didn’t pay for sounds like a dream come true. But that’s not the case for a Rhonda Joy Erwin of Elanora, Australia. When Erwin was treated by Dr. Mark Doyle, a local plastic surgeon, she claims he performed a scar removal procedure on her breast while she was under anesthesia for another, unrelated procedure – and that he did so without her consent. Even worse, when Erwin awoke to discover the additional procedure, she says the procedure was botched, requiring immediate removal of her breast implants from a prior surgery with a different doctor. She is now suing Doyle for medical negligence.

Dr. Bruce Chau is a plastic surgeon based in Berkeley, Michigan. He says this type of case is extremely rare, but it highlights why patient consent is so important.

“What the doctor did in this case was extremely unethical,” says Chau. “But beyond that, to do something unethical and then do it incorrectly, it’s unforgivable.”

According to Chau, though it is very rare for a doctor to perform additional surgeries on a patient without their consent, there are times when the doctor has no choice.

“With plastic surgery, sometimes you will attempt a procedure and see that something else needs to be adjusted or corrected to make the current surgery viable,” he says. “For example, a second surgery may be needed to support the main surgery. For example, your surgeon may take a portion of rib bone to support the nose during a rhinoplasty.”

Still, in those cases, Chau says that patients usually are forewarned that this type of extra may be a possibility.

“Your surgeon should tell you ahead of time if he thinks there’s a possibility that he will need to remove tissue, fat or bone from elsewhere in the body,” Chau says. “But he should not be taking liberties to ‘fix’ someone else’s work without the patient’s consent.”