Jade was 16 when she first found a lump in her breast. Fear sent hot prickles over her skin as she felt the hard mass meet her palm one morning in the shower before college. She was too young. This was nothing, surely?
She spoke to her parents and together they agreed she would have it checked out - better safe than sorry. Her GP referred her to Spire Hospital in the West Midlands, to a surgeon named Ian Paterson. Jade’s GP spoke highly of him, he was a breast surgery expert: the best at what he did, and he lived up to that reputation. At the appointment he did everything he could to put Jade at ease. “I was 16, having to get topless in front of this strange man, but he made me feel so comfortable. I thought he was absolutely lovely,” she says, reflecting on that first appointment 15 years ago. “He was so good at making you feel safe.”
After a quick look at the lump, Paterson told Jade that it would have to be removed – sooner rather than later. “He told me it was a fibroadenoma [one of the most common types of benign breast lump]; and that because of the size of it [according to Paterson it was the size of a golf ball], it needed to come out quickly, so he booked me in to have the surgical procedure about two weeks later.”
A fortnight later, Jade’s parents waited nervously in a sterile blue and white waiting room while Paterson cut into their 16-year old daughter’s chest, performing a procedure known as a ‘wide local excision’. They choked back tears and held their breath as Jade was wheeled out of surgery, trying to hide their distress from the daughter who needed their support. A week later Jade was back in Paterson’s consulting room. The surgery had been successful, he told her.
“He said it was a fibroadenoma, just as he had thought, and that it was large, so it was good that they had found it and taken it out,” she says. Jade then went back again one more time to have her stitches removed. “Then we were sent on our way and that was kind of that. As far as I was concerned, he had saved me in a way.”
Unfortunately Jade would find three more lumps over the next three years. But she and her parents knew who to see: Mr Paterson, who, by the time Jade was 19, had called her in for three further surgeries to remove the lumps. “My faith in him grew every time,” she says. She and her parents felt thankful that – even these times of uncertainty – they could rely on Mr Paterson to be as caring and comforting as that first time.
Then, aged 25, Jade was called into an office at the same hospital. But it wasn’t Paterson sitting at the other side of the desk. It was a new doctor, who steeled himself, before telling her that Paterson had been suspended from his role. He was being accused of mutilating his patients. That she was one of hundreds of patients who were being recalled into the hospital, and that three of her four breast surgeries had been completely unnecessary. She may not even have needed the first one.
In 2017 Paterson was sent to prison for intentionally wounding hundreds of people in a campaign of abuse that lasted decades. From at least as far back as 1998, Paterson performed unnecessary mastectomies, which the jury called “extensive, life-changing operations for no medically justifiable reason.” He told some people they had cancer, when they did not. Others, who had cancer, were left vulnerable to the disease after he performed a procedure he’d invented, called a ‘cleavage sparing mastectomy’ which was designed to leave some breast tissue behind, thus allowing the cancer that was there to continue to spread.
“That is something that he has coined,” says Dr Lucy Khan, a consultant oncoplastic breast surgeon. “It's not something that's come from the breast surgery community at all. I can't be stronger in stressing that. There is no such thing as a cleavage sparing mastectomy. You shouldn't be leaving a large amount of tissue like that and calling it a mastectomy. Absolutely no-one in the world should be doing that.”
For Jade, Paterson’s career of terror meant that by the time she was 19 she’d had four major surgeries. The life-changing and overwhelming procedures that she had spent years coming to terms with turned out to have been needless. Simply the whim of a man whose motives are still not fully clear; whether for money, the result of a god complex, or both.
In her first appointment with him, Paterson was charming, friendly and relaxed; sending her the message that it was no big deal but she would need an operation to remove the lump. He didn’t scan or biopsy the lump before committing Jade to intrusive and life-changing surgery.
When you find a lump in your breast, the first thought is often cancer. But lumps can appear in breast tissue for a number of reasons, not all of them cancer. Before committing Jade to surgery, Paterson should have followed the recognised protocol for examining and diagnosing a breast lump, according to Dr Khan.
“Under standard practice a breast lump is assessed by what we call ‘triple assessment’, she says. “This means you do three things; the patient is examined by a surgeon or another experienced breast clinician. Secondly, you’d do some type of scan such as an ultrasound scan. And thirdly you’d administer a needle biopsy. Fibroadenoma in a young girl [as in Jade’s case] doesn't always need the needle biopsy. But there should still have been an ultrasound scan to show that it is a fibroadenoma, and nothing cancerous.”
At some point during the first surgery Jade spotted that Paterson had also written on the paperwork that it was a ‘cancerous operation’. “We don't definitely know why he did that,” she says. “But there is speculation that it’s because he gets paid more for a cancerous operation. Because the operation I had was different to what I’d agreed to have, I’d technically not even consented to it.”
Including the first surgery Jade had a total of four procedures called ‘wide local excisions’. Operations which, according to Dr Khan, are not performed on fibroadenomas like the ones Paterson told Jade she had.
“A patient with a fibroadenoma does not require a wide local excision,” she explains. “Sometimes there's a concern that what we think is a fibroadenoma is something more serious or something slightly unusual, and that would then potentially need a wide local excision, but you can’t really know that or be thinking about these things unless you had a biopsy confirming it beforehand through the triple assessment.”
Each time Jade found a lump in her breast, she and her parents would return to Paterson. “It was very samey every time,” she says. “Every time he adopted that no-problem attitude, it would leave you feeling good, like he had found the thing that was wrong with you and he would fix it. You felt safe with him, comfortable with him, you knew how he'd make you feel. It was like seeing a friendly, familiar face. It was never a big drama: I always thought 'it's alright, Mr Paterson will take care of it'. It was as though he preyed on that,” says Jade. “He made you feel like he was doing you a favour.”
Although she was one of his youngest patients, Jade was one of hundreds that we know of who bore physical and emotional scars at the hands of Paterson. The 2020 inquiry into the healthcare facilities in which he operated tells mainly of women left with constant pain, mutilated breasts and psychological turmoil. Other women detail not being able to breastfeed their children. Some of his private patients fell into financial difficulty trying to pay for surgeries, and of course there were those who died as a result of cancers allowed to spread.
“When I found out about his crimes I really struggled to get my head around it,” says Jade. “As far as I was concerned, I’d had something wrong with me and he fixed it. I had this admiration of him, and my parents saw him as the person who’d healed their daughter. I even felt bad speaking about it, like I was betraying the person who’d helped me. It was only when I started reading about it in the press that it began to feel more real.
“My dad has always said that the first time Paterson told me I would have to have the surgery, he remembers turning to me and saying, ‘look Jade, if the man says you've got to have it done, you've got to have it done.’ Now, my dad says he constantly replays that conversation in the back of his mind. He thinks, 'should I have questioned it? Should we have got a second opinion?' He still feels guilty for telling me, 'this guy knows best'.
“But who else are you meant to trust? He’s in this position of power. He's the specialist. He's the expert. Why would you question it? It's only now that we know what we know. But hindsight is a wonderful thing.”
At the time, Jade struggled to see the situation with such clarity. She was a teenage girl, trying to live like any other teenager, trying desperately to ignore the weight of the situation.
“I was in college when this all started, I was 16 and I wanted to live a normal teenage life, but all the things my friends were doing I couldn't do. At that age you're so body conscious anyway, and I was having to reconcile myself to the fact that there were going to be scars on my body forever. I thought 'are people going to think it's weird? Are people going to think that it's unattractive?' I panicked realising I was going to have to explain this to every boyfriend I ever had.
“And as I've got older I have had to explain it to people; the scarring is visible, so it’s not something I can avoid in intimate situations. I have to explain everything that happened, and straight away people see me as a victim. That’s not a way that I would refer to myself, ever. I think of myself as strong and independent. And I hate that there’s this thing that's happened to me that makes me a 'victim' in other peoples' eyes.”
But it was only as a result of the strength and determination of his patients that people didn’t stop talking about Paterson after he was convicted. Three months after he was sentenced, a judge increased his jail time from 15 to 20 years, and in February of this year an independent inquiry found that the way NHS and private hospitals he’d worked at had functioned, had allowed him to “hide in plain sight”.
The inquiry found that it was “a culture of avoidance and denial” in a “dysfunctional” system where there was “wilful blindness” to his actions. It ended by saying that his patients “were let down time and time again”, not just by Paterson, but by a number of “individuals, organisations and institutions … [that] should have kept patients safe but failed to do so”.
Jade is now 31, a mum with a career and a happy, no nonsense attitude. She sees everything that happened as part of a bigger issue, “Obviously the inquiry was a positive thing. It highlights that these issues exist, and that’s why it was such a big relief for a lot of people; it made it clear that it wasn't just about him. That people in positions of trust need to be held to account.”
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