It would be “crazy” to leave behind breast tissue during a mastectomy, disgraced surgeon Ian Paterson has told an inquest into the death of one of his patients.
The jailed former consultant, who is serving a 20-year sentence for wounding 10 patients after being convicted in 2017, spoke at the inquest of Elaine Turbill, who died aged 63 in 2017 after her breast cancer returned despite undergoing a mastectomy carried out by Paterson in 2005.
Paterson, who was educated in Bangor, performed an unauthorised “cleavage-sparing” mastectomy on Mrs Turbill and other cancer patients, which left behind breast tissue for cosmetic reasons but increased the risk of cancer returning.
Giving evidence remotely from prison to the inquest, the second of 62 to be heard at Birmingham and Solihull Coroner’s Court over the next eight months, Paterson claimed it was not him who coined the term “cleavage-sparing mastectomy” and said the phrase had “caused the hysteria”.
When asked by counsel to the inquest, Jonathan Jones KC, whether he considered he had been a good breast surgeon, Paterson, who wore a pale blue shirt with a poppy attached for the hearing, said: “I don’t think people go around assessing themselves but yes, if I thought I was a bad breast surgeon I shouldn’t be doing it, should I?
“You seek help from colleagues if you feel there is something wrong with your technique. You rely on your colleagues to tell if they think there is something wrong with your technique – that’s what MDTs (multidisciplinary team meetings) are for.”
One of Paterson’s colleagues, radiologist Dr Chris Fletcher, told the inquest on Wednesday that the breast surgeon was a “nightmare” to work with and that multidisciplinary meetings between NHS colleagues to discuss the treatment of their patients were “always difficult” because Paterson “always tried to run the show”.
When asked on Thursday what his recollection of the meetings was, Paterson admitted there were “tensions” but said they largely related to the heavy workload they had to deal with.
He added that there were also tensions between himself and colleague Dr Andrew Stockdale, who raised concerns about the amount of residual tissue that was being left behind by Paterson during his mastectomies.
He said: “(Dr Stockdale) expressed his views outside the MDT, he decided he would collect a cohort of patients he felt exhibited his concerns and instead of sharing them with me or the MDT, he shared them with a third party.”
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When asked if he agreed with Dr Stockdale that there was residual tissue left behind during the mastectomies he performed, Paterson said: “We’re getting onto the concept of the cleavage-sparing mastectomy.
“It wasn’t me who coined that phrase, I think he did. A CSM is the thing that seems to have created the hysteria, the furore, whatever you want to call it.
“For a limited number of patients, it was possible, if the cancer was central or lateral and they had a larger than average breast, it was possible to leave slightly thicker flaps.
“A thicker flap doesn’t leave breast tissue behind. No breast surgeon will ever tell you 100% of breast tissue is removed during a mastectomy, it is nonsense. No mastectomy is ever fully complete.
“No surgeon aims to leave breast tissue after a mastectomy, that’s just crazy.”
Paterson said he did not specifically remember Mrs Turbill, but was asked by Mr Jones whether he would have explained to her what a mastectomy was.
He said: “Most ladies know what a mastectomy is, I never went into great detail, it scares them and I don’t think they hear it, they just hear the word cancer.
“Not long after the diagnosis and the plan, this lady would have been taken into a separate room with a breast care nurse and would have discussed things in more detail.
“We leant on our breast care nurses a lot for information delivery.”
Mr Jones asked: “Would you have told Elaine it wasn’t possible to do a complete mastectomy?”
Paterson replied: “No, because all of us do our best to remove all visible breast tissue, but it is a worrying and frightening detail to tell them there may be deposits of breast tissue left behind which could see a local recurrence (of cancer).
“The nurses would have mentioned it as a possibility in the future as part of the preparation.”
The inquest continues.