Procedures performed by a convicted British breast surgeon were not a recognised or authorised type of operation, with an inquest hearing last week that Ian Paterson had pitched his so-called cleavage-sparing mastectomy to a patient “almost like a sales job”.
Chloe Nikitas, an environmental consultant, died in 2008 at 43 from breast cancer that returned three years after having a mastectomy she believed had removed all of her breast tissue.
She is the first of 62 patients operated on by Paterson (66) whose deaths are being investigated as part of one of the largest inquests in British history, to find out whether the surgeon’s actions caused their deaths.
The Guardian reports that the unscrupulous breast surgeon subjected more than 1 000 patients to unnecessary and damaging operations over 14 years before he was stopped, an independent inquiry has found.
He performed harmful surgery on mainly female patients in NHS and private hospitals because of “a culture of avoidance and denial” in a “dysfunctional” healthcare system where there was “wilful blindness” to his behaviour, according to the inquiry, which found that victims were “lied to, deceived and exploited” by Paterson, now serving a 20-year jail sentence imposed in 2017 for wounding with intent and unlawfully wounding nine women and one man whom he treated between 1997 and 2011.
He refused to attend Nikitas’sinquest last Tuesday.
A prison supervisor told the hearing that in a conversation with Paterson on Tuesday morning the former surgeon said the “coroner isn’t investigating fairly”, he felt he wasn’t being “listened to” and the proceedings were “biased”.
Judge Foster, who is leading the inquests, can impose a fine of up to £1 000, refer Paterson for possible prosecution or refer him to the Attorney-General for contempt of court. He said he would reserve his judgment in the hope Paterson would change his mind and attend future inquests.
Nikitas’ partner, Klaus Ströhle, told the inquest the couple had trusted Paterson, who told them he had “pioneered” a new type of surgery that would preserve the appearance of her cleavage after the breast tissue removal.
“It was almost like a sales job – this is the latest new thing he has developed, and there’s nothing to worry about, it’s going to be great,” said Ströhle. “We just assumed this was the new state-of-the art methodology. We were not aware this was something that had not been sanctioned.
“We weren’t made aware there would be an increased risk of (cancer) recurrence if breast tissue was left behind… if we had been aware of that, I can assure you we would not have gone for this option. We assumed this was the best course of action.”
Nikitas was offered no alternative type of operation, he said.
Cleavage-sparing mastectomies, as they were later named by Paterson, were not a recognised or authorised type of operation. They involved leaving some breast tissue behind, instead of completely removing it as was standard procedure in a mastectomy.
Nikitas was first diagnosed with breast cancer in 2002 and underwent a mastectomy the same year, and then further treatment. In April 2005 she discovered a lump in the same breast, later found to be grade 2 ductal breast cancer – the same cancer as before – that had spread to other parts of her body.
“We were told it was a one in a million chance, that it was just bad luck,” said Ströhle. “It was metastatic, and it was terminal.”
After her surgery, Nikitas was referred to a consultant oncologist, Dr Tal Latief, for chemotherapy.
He told the inquest he had no idea Paterson had been performing cleavage-sparing mastectomies on his patients as the surgeon never used that terminology. He had been shocked to read about it in the media.
“I was really shocked, because I had never heard the term cleavage-sparing mastectomy. Other surgeons never mentioned it to me or did it,” he said. “Paterson only referred to mastectomy, so I treated patients as having had mastectomies. I had no reason to doubt it.”
The inquest continues.
See more from MedicalBrief archives:
Culture of ‘avoidance and denial’ facilitated unnecessary operations – inquiry
UK breast surgeon found guilty of wounding with intent