The number of “cleavage-sparing mastectomies” carried out by disgraced breast surgeon Ian Paterson is “inflated”, he has told an inquest for one of his patients – as he claimed it was not a new operation he performed but simply an “adaptation”.
Giving evidence via video link from prison on Thursday, Paterson, 66, told Birmingham and Solihull Coroner’s Court at Elaine Turbill’s inquest that he stopped performing his version of a mastectomy as soon as he was informed by hospital chiefs in 2007 that more research was needed.
The cleavage-sparing mastectomy – a term Paterson claimed he did not invent but agreed it was “vaguely descriptive” of the procedure – left behind breast tissue for cosmetic reasons, giving the impression of a fuller bust, but is believed to have increased the risk of cancer returning, something he denied.
The breast surgeon, who is serving a 20-year jail sentence for wounding 10 patients after he was convicted in 2017, told the court he had “adapted” a traditional mastectomy to allow for more subcutaneous fatty tissue to remain and did not feel he needed to gain specific consent for this from the patient because it was not a different procedure.
He said: “There is misconceptions and hysteria in relation to the term ‘cleavage-sparing mastectomy’. It was a limited intraoperative adaptation. It was done to improve cosmesis and I never considered it to be a separate procedure and never described it as such.
“Very few ladies were actually suitable for this kind of intraoperative adaptation which is why I have been surprised at the number of supposed CSMs discovered in my practice.
“I can’t believe they are accurate. I didn’t keep a log – I didn’t think it was a different operation, it was an adaptation, so I never kept any figures.”
Paterson explained it was his belief that it was possible in some cancer patients who had larger breasts to be able to leave subcutaneous fat, well away from the cancer site and with no breast tissue in the area, to give the impression of a cleavage.
He said: “I immediately stopped when someone said there was a problem. I was told any intraoperative adaptations should be stopped and I signed a letter in December 2007 saying I would cease them.
“I have a recollection of getting an email from the then-clinical director who said it wasn’t something they should be allowing me to do until we have researched it more. I was told I would need patients to consent to it.
“I stopped immediately. If you’re telling me I’m doing something that might be harming my patients, I’m not going to do it, I’m going to stop.”
Asked by counsel to the inquest Jonathan Jones KC whether patients needed to be informed that he was not performing a standard mastectomy, Paterson replied: “You’re making it sound flippant, but this is a lady losing her breast.
“The lady is entitled to know her cancer will be gone and the person operating will do everything they can to remove the cancer safely in its entirety.
“It was possible to give them a better cosmetic result. You haven’t spoken to the women who go home and won’t let their husbands near them, or the women who take down all the mirrors in the house because they can’t stand to look at themselves.
“If you had seen that, you would want to do your level-best to make them feel better.”
The former surgeon maintained that the procedures he carried out were still “oncologically safe” and said it was rare for women with breast cancer to get a local recurrence after a mastectomy.
Asked if he was certain that no breast tissue remained after his mastectomies, Paterson replied: “You are not going to get me to say I deliberately left behind breast tissue. I could be as near as possible to certain I was not leaving behind glandular tissue.
“No breast surgeon aims to leave breast tissue behind. My view was a standard mastectomy removes all the visible breast tissue and a CSM is a safe oncological procedure and as soon as someone suggested to me it might not be, I stopped doing it.”
Paterson is expected to give evidence again next Thursday at the third inquest in a series of 62 touching on the deaths of his former patients.
The inquest into the death of Christine Baker is due to get under way on Monday.
