By james art 
PA MediaA disgraced former breast surgeon has told an inquest into the death of one of his patients that the number of “cleavage-sparing mastectomies” he reportedly performed was “inflated”.
Ian Patterson was jailed for 20 years in 2017 for injuring 10 patients by performing an unauthorized procedure that left behind tissue.
New inquests are investigating the deaths of 62 patients, including 63-year-old Elaine Turbill in 2017, 12 years after Patterson performed a mastectomy on her.
Giving evidence from a distance from prison, he said it would be “madness” to leave breast tissue during such an operation.
He also denied that it was a new operation he had performed, but rather an “adaptation” and denied coining the term “cleavage-sparing mastectomy.”
In Patterson’s trial seven years ago, the technique involved leaving some breast tissue, preserving the patients’ cleavage.
However, the inquest heard it also increased the risk of the cancer returning – a point the surgeon denied on Thursday.
He told the coroner he stopped performing his version of the mastectomy as soon as he was informed by hospital bosses in 2007 that more research was needed.
Speaking in general terms, he said breast surgeons aimed to remove all breast tissue when they performed a mastectomy, but in practice this was never 100% successful.
As evidence, he distinguished between glandular breast tissue – which produces milk – and subcutaneous fat, some of which he would keep.
The inquest previously heard that when she was examined in 2010, Elaine Turbill had 20% of her breast tissue left by Patterson.
But he said it was “not an objective measure” and told the inquest that when he carries out operations of this type he is “as sure as possible that I’m not leaving any glandular breast tissue behind”.
He questioned why the residual tissue in Ms Turbill had not been noticed before this time and suggested it could be fat that had grown since the 2005 operation.
“Better cosmetic result”
He told the inquest that he discussed the possibility of cosmetic reconstructive surgery with her, but she turned him down.
Patterson went on to say that it’s not usually his practice to discuss the details of surgeries with his patients because he feels it scares them.
Instead, he said he left those conversations to the nurses.
Asked by inquest barrister Jonathan Jones QC whether patients should be informed that he does not perform standard mastectomies, Patterson said: “It sounds frivolous but this is a lady who is losing her breast.
“A woman has the right to know that her cancer will go away and that the person operating will do everything in their power to safely remove the cancer in its entirety.
“It was possible to give them a better cosmetic result. You haven’t talked to the women who come home and don’t let their men 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’d seen that, you’d want to do whatever you could to make them feel better.”
Paterson, who practiced as a consultant surgeon from 1998 to 2011, treated patients at Solihull Hospital, then part of the Heart of England Foundation NHS Trust.
He is also in private practice at Parkway Hospitals in Solihull and Little Aston in Sutton Coldfield, both run by Bupa until 2007 and then by Spire.
The surgeon said there had been a heavy workload at the Heart of England trust and this had caused strain.
The inquest heard that another surgeon, Andrew Stockdale, raised concerns about the amount of residual tissue left after mastectomy operations carried out at the trust where they both worked.
Patterson said he was aware his colleague had been collecting evidence about this but that the issue had not been raised at multidisciplinary team meetings, which bring together NHS colleagues to discuss a patient’s treatment.
One of his colleagues, radiologist Dr Chris Fletcher, told the inquest on Wednesday that working with the breast surgeon was a “nightmare” and that multidisciplinary meetings were “always difficult” because Patterson “always tried to run the show”. .
The investigation continues.