edical malpractice litigations are common in the United States. Physicians face a 7.4% risk of being sued for malpractice. 1 Fifteen percent of plastic surgeons may have a malpractice lawsuit filed against them each year. 2 Surgical negligence, defined as failure to provide standard of care expected from the surgeon, is a key principle in the plastic surgery malpractice industry. 2,3 The U.S. legal system seeks to prevent malpractice by monetarily penalizing negligent providers and rewarding injured plaintiffs. 3 Thus, it is important to differentiate negligence from adverse events (eg, injuries inherent in medicine), 3 which are discussed with patients during the informed consent process. Most malpractice litigations are ruled in favor of defendants, but the process of lawsuit can be psychologically and financially demanding regardless of the case result. 1,2 Physicians devoting time and money to defend themselves in the court may compromise patient care. 4 Malpractice litigations can contribute to physician burnout and job dissatisfaction as well. 5 Thus, understanding factors associated Background: Up to 7.4% of physicians in the United States face the risk of undergoing medical malpractice litigation each year. Breast reduction operations are performed often, but specific factors of breast reduction malpractice litigation associated with the outcome and indemnity payments to plaintiffs are unknown. Methods: Using the Westlaw legal database, the authors analyzed plaintiff and defendant characteristics, alleged reasons for malpractice, case outcomes, and payments to plaintiffs among medical malpractice lawsuits involving breast reductions with final jury verdicts or settlements, using logistic regressions. Results: Ninety-six malpractice litigations with jury verdicts or settlements involving breast reduction operations between 1990 and 2020 met the authors' inclusion/exclusion criteria. The average reported plaintiff age was 39 ± 15 years. A total of 28% ± 29.2%, 48% ± 50.0%, and 20% ± 20.8% cases occurred in the 1990 to 1999, 2000 to 2009, and 2010 to 2020 periods, respectively; 15% ± 15.6% of cases were held in New York. Most cases were in favor of defendants [n = 65 (67.7%)]. Among 14 cases (14.6%) with nipple malpositioning as a sustained injury, eight of them (57.1%) were ruled in favor of plaintiffs. Nipple malpositioning had increased odds of plaintiff verdict or settlement versus defendant verdict (OR, 1.