Paterson medics did not spot breast tissue

Chloe Nikitas was first diagnosed with breast cancer in 2000, two years after her son Max was born

Medics who treated a woman following a mastectomy carried out by jailed breast surgeon Ian Paterson did not notice any remaining breast tissue, an inquest has heard.

Chloe Nikitas, from Tamworth, died in 2008 at the age of 43 after her cancer recurred following Paterson's "cleavage-sparing mastectomy".

Her inquest is the first of 62 to be heard at Birmingham and Solihull Coroner's Court, looking into the deaths of Paterson's former patients.

Plastic surgeon Chien Kat told the court she could not accurately have told the difference between her patient's subcutaneous tissue and breast tissue.

Ms Kat performed a breast reconstruction on Ms Nikitas immediately after Paterson completed her operation.

She told the inquest: "After a mastectomy it is very, very difficult for me to differentiate between what is just left behind subcutaneous tissue or even a thin layer of breast tissue, as it all looks the same."

Paterson is currently serving a 20-year jail sentence after being found guilty in 2017 of multiple counts of wounding, relating to 10 of his patients.

The inquest heard on Tuesday he had operated on Ms Nikitas when a biopsy found cancer in her left breast in 2002.

But the procedure left behind breast tissue, and her cancer returned in 2005 and was terminal.

Ms Kat, who was based at Spire Parkway in Solihull, told the inquest on Wednesday she would routinely check to see whether breast tissue had been removed during her reconstructions.

She denied a former assertion from Paterson that he had asked her to remove breast tissue he missed during his surgeries.

“Knowing what I know of Mr Paterson now, I’m not surprised that he has tried to extricate himself from this situation by putting forward these theories," she said.

Chien Kat carried out a breast reconstruction on Chloe Nikitas in 2002 immediately after Ian Paterson performed a mastectomy

Ms Kat shared notes with the inquest from her first meeting with Ms Nikitas in July 2002, revealing her patient consented to a "skin-sparing mastectomy".

The inquest heard Ms Nikitas had not wanted a silicon implant, so instead had an extended latissimus dorsi flap reconstruction, with muscle and tissue taken from her back and inserted under the skin of her breast.

The plastic surgeon confirmed she had taken Ms Nikitas's consent form for both the mastectomy and subsequent reconstruction.

She told the inquest it was "almost impossible" to expect "absolutely no breast tissue" would be left behind following a mastectomy.

"One would hope that the breast tissue left behind is absolutely minimal," she said.

Miss Nikitas's former partner Klaus Ströhle questioned whether the amount of tissue left behind by Paterson had "set off any alarm bells", since the patient was slight.

"In Chloe’s case I would not have expected a thick layer of fat to be left there, or I would have raised alarms," she said.

Ian Paterson was jailed in 2017 after being convicted of multiple counts of wounding

The inquest also heard evidence from radiologist Dr Arpan Banerjee, who previously worked both at Heartlands Hospital in Birmingham and also privately.

He did an ultrasound on Ms Nikitas in April 2005 when she discovered a new lump under her left arm.

He said he detected a "tiny lump" in her armpit during a "very thorough ultrasound examination" but it did not worry him at the time.

When asked by counsel to the inquest Jonathan Jones whether the scan would have identified breast tissue, Dr Banerjee said the back tissue used for her reconstruction made it impossible to tell.

"If there is fat that has been left behind following a mastectomy, there is no way one can distinguish one from the other," he said.

"Also, when you examine a reconstructed breast following a mastectomy you're not expecting to find left-behind breast tissue," he added.

He told Mr Jones it would have been Paterson's job to decide whether to investigate the node further.

"When the node is that small you cannot detect it with certainty and that is the difficulty," he said.

"Back then teaching was, usually if a node is under a centimetre and there is no abnormal shape it would be acceptable to follow it up."

The court heard on Tuesday a biopsy six months later found a Grade 2 ductal cancer, the same grade as Ms Nikitas's original cancer.

She died at the Priory Hospital in Edgbaston in 2008.

Dr Banerjee also told the court he had not been aware of any concerns about Paterson's surgeries until the consultant was placed under investigation in 2007.

"I had no communication in the whole of my career from anyone in management about anything that was happening to Mr Paterson," he said.

"I knew vaguely that there were some issue about his mastectomies at that time but we were reassured that everything would be sorted out."

Paterson refused to attend the first day of the hearings on Tuesday because he felt proceedings were "biased" and he had not had full access to court documents.

The inquest continues.