## Facts

- Alice Sullivan, a professional entertainer, consulted Dr. James H. O’Connor, a plastic surgeon, for cosmetic surgery on her nose.
- Sullivan alleged O’Connor made a special contractual promise to improve her appearance by performing two operations to make her nose more pleasing in relation to her other features.
- Sullivan underwent three operations, and her appearance worsened; her nose became permanently misshapen and not capable of improvement by further surgery.
- Sullivan could not prove loss of employment caused by the result but proved disfigurement and associated distress.
- The parties stipulated Sullivan’s out-of-pocket payments for surgeon and hospital expenses totaled $622.65.

## Issues

1. In a breach-of-contract action based on a physician’s special promise of a specific result, whether damages are limited to out-of-pocket expenditures.
2. Whether reliance-type damages may include compensation for worsened physical condition (disfigurement) caused by the breach.
3. Whether pain, suffering, and mental distress associated with an unbargained-for corrective procedure may be recovered as foreseeable contract damages.

## Decision

- The Supreme Judicial Court of Massachusetts affirmed judgment for Sullivan on the contract claim.
- Damages were not limited to restitution (fees and expenses) and could include reliance losses.
- The plaintiff could recover for the worsening of her condition (disfigurement) attributable to the breach.
- The plaintiff could recover for pain, suffering, and mental distress tied to the third operation undertaken to address consequences of the failed promised result.
- The court found no error in instructing that recoverable damages were those flowing directly, naturally, proximately, and foreseeably from the breach.

## Legal Principles

- Where a physician makes a special contractual promise to produce a particular result, liability in contract may exist even if negligence is not proven.
- In such cases, reliance damages may be preferred over full expectation damages when valuing the promised outcome is speculative or risks disproportionate awards.
- Reliance damages may include the difference between the plaintiff’s pre-performance and post-performance condition when the plaintiff’s detrimental change results from reliance on the promise.
- Contract damages may include pain, suffering, and mental distress when those harms are a foreseeable consequence of the breach under the circumstances.
- Foreseeability limits contract damages to losses that flow directly, naturally, proximately, and foreseeably from the breach, considering the parties’ context (including the plaintiff’s occupation).

## Conclusion

The court upheld a contract verdict against a cosmetic surgeon who promised an improved appearance but produced permanent disfigurement, holding that recovery could extend beyond reimbursement of fees to reliance damages that included disfigurement and foreseeable pain and emotional distress associated with corrective surgery beyond the original bargain.


Sullivan v. O’Connor, 363 Mass. 579, 296 N.E.2d 183 (1973)