Convicted breast surgeon Ian Paterson offered an unauthorized cleavage-sparing mastectomy to one of his patients “almost like a sales job”, an inquest has heard.
Chloe Nikitas, an environmental consultant from Tamworth, died in 2008 aged 43 from breast cancer that returned three years after a mastectomy from which she thought all her breast tissue had been removed.
She is the first of 62 patients operated on by Paterson 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.
Paterson, who is serving a 20-year prison sentence after being convicted of multiple battery charges in 2017, refused to attend Nikitas’ inquest on Tuesday.
A prison supervisor told the hearing that he had a 20-minute conversation with Paterson on Tuesday morning in which the 66-year-old former surgeon said the “coroner is not conducting a fair investigation”, he felt he was not being “listened to”. ‘ and the procedure was ‘biased’.
Judge Foster, who is leading the inquest, 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 judgment in the hope that Paterson would change his mind and attend future inquests.
“It’s a disappointment to me, but more importantly to the relatives who have questions that need to be answered,” he said.
Nikitas’ partner of 18 years, Klaus Ströhle, told the inquest how 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 removal of the breast tissue.
“It was almost like a sales job – this is the latest new thing he has developed, and there is nothing to worry about, it will be great,” said Ströhle. “We just assumed this was the new state-of-the-art methodology. We didn’t know this was something that wasn’t approved.
“Chloe was very analytical. We were not aware that there would be an increased risk of (cancer) recurrence if breast tissue were left behind, absolutely not. If we had been aware of this, I can assure you that we would not have chosen this option. We assumed this was the best course of action.”
Nikitas was not offered an alternative type of surgery, he said.
Cleavage-sparing mastectomies, as they were later called by Paterson, were not a recognized or authorized form of surgery. They left some breast tissue behind, instead of removing it completely, as was standard procedure for a mastectomy.
Nikitas was first diagnosed with breast cancer in 2002 after noticing discomfort in her left breast while breastfeeding her son.
She underwent a mastectomy and further treatment the same year. 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 – which had spread to other parts of her body.
“We were told that we were extremely unlucky, the chance was one in a million that it was just bad luck,” said Ströhle. “We were under no illusion that this was a death sentence. It had spread and was terminal.”
After her surgery, Nikitas was referred to an oncologist, Dr. Tal Latief, for chemotherapy. He told the inquest he had no idea Paterson had performed cleavage-sparing mastectomies on his patients, as the surgeon never used that terminology, and was shocked to read about it in the media.
“I was really shocked because I had never heard the term cleavage-sparing mastectomy before. Other surgeons have never said or done it to me,” he said. “(Paterson) only referred to mastectomy, so I treated patients as if they had had a mastectomy. I had no reason to doubt it.”
In a statement read out at the start of the hearing, Nikitas was described as an “incredibly smart woman” who was “compassionate, passionate (and) never afraid to speak her mind.”
The investigation continues.