Expert Criticizes Surgeon Ian Paterson's Procedure
A medical expert has stated that Ian Paterson, a jailed surgeon involved in investigations regarding patient deaths, performed an "ad-lib operation" for which he "did not have the expertise."
Consultant breast surgeon Prof Nigel Bundred testified at a hearing concerning the death of Marie Pinfield, indicating he did not recognize the type of surgery Paterson claimed to have performed.
Pinfield, a child protection officer with West Midlands Police, had cancer in her left breast but died in 2008 after the cancer spread to her lungs.
The inquest revealed that Pinfield wished to have a completely flat chest wall after surgery, but following two surgeries by Paterson, she retained B to C cup breasts.
Paterson, who practiced in the West Midlands, is currently serving a 20-year prison sentence after his 2017 conviction for multiple counts of wounding due to botched and unnecessary operations.
Ongoing inquests are examining whether the deaths of 68 women who were his patients resulted from his treatment and care.
Family Testimony and Consent Details
Shirley Moroney, Pinfield's sister from Solihull, told the inquest that Pinfield wanted a bilateral mastectomy despite Paterson telling her she was "too young" and stating,
"You can't possibly want that."
The consent form signed by Pinfield specified a bilateral mastectomy, meaning removal of both breasts, although only the left breast was cancerous.
Disputed Surgical Plan and Terminology
Throughout the inquest, Paterson claimed that the plan was never for a standard mastectomy but rather a "bespoke oncoplastic modification." He described the surgery as a "subcutaneous mastectomy reduction," a term he also used in correspondence with Pinfield's GP.
When questioned by inquest counsel Briony Ballard about the meaning of "subcutaneous mastectomy reduction," Prof Bundred responded,
"I don't think I know what [it] is."
He elaborated,
"I have no idea what [it is] because you can't do a mastectomy with a reduction. A reduction means you're leaving tissue behind, significant amounts of tissue behind."
Prof Bundred suggested,
"I can only assume it's an ad-lib operation [Paterson] decided to carry out himself."
He explained that the conventional method to remove a breast tumor involves operating from the skin to the chest wall to ensure complete excision, which Paterson did not follow.
Concerns Over Surgical Approach and Patient Priorities
Paterson discovered additional cancer during the second surgery on Pinfield.
Prof Bundred stated,
"It seems he was more concerned with the cosmetic appearance which Marie Pinfield had clearly said she wasn't concerned about."
He added that Pinfield
"had never expressed a desire to have breast conserving surgery."
Prof Bundred also asserted that Paterson lacked the expertise to perform such a procedure on Pinfield and that this approach was inappropriate for a patient with a large tumor and large breasts.
He noted,
"[He] wasn't trained to do anything other than mastectomy for [that] breast size."
Tumor Characteristics and Surgical Suitability
Prof Bundred described Pinfield's tumor as "very fast growing" and "a very nasty cancer," suggesting the surgery performed was not necessarily suitable.
He criticized Paterson for providing inadequate advice to Pinfield regarding surgery, stating that she should have been advised to have a mastectomy only on her left breast, as the right breast was cancer-free.
Prof Bundred recommended that Pinfield could have a reduction on her right breast later, which would have shortened the time before starting chemotherapy.
He explained that improper advice increased the risk of complications and delayed chemotherapy initiation.
Oncologist's Perspective on Chemotherapy Timing
Consultant oncologist Pat Price also provided her opinion at the inquest, stating that earlier chemotherapy would not have saved Pinfield's life.
She said,
"We know this lady did not respond to chemotherapy and therefore, if patients do not respond, we cannot say starting 31 days earlier would make them magically respond."
"Starting treatment 31 days earlier would make no difference."
Prognosis and Outcome
Prof Bundred expressed that he did not believe Pinfield's life could have been saved but that she might have lived longer.
He stated,
"Marie would have died from her cancer with or without treatment."
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