Stephen McCulley, Reconstructive and Aesthetic Surgeon. MBChb, FCS(SA)Plast, FRCS(plast)

The Truth Behind ‘Cleavage Sparing Mastectomies’

“Weak, indecisive and secretive” hospital managers have been blamed for the tragic case of breast surgeon Ian Paterson being able to continue to perform dangerous breast cancer procedures on patients for 8 years.

Ian Paterson allegedly performed unnecessary operations on 450 women and he is also accused of performing ‘cleavage sparing mastectomies’ in which breast tissue was not removed and which could increase the risk of cancer.

Below Stephen McCulley explains what cleavage sparing mastectomies are and shares his thoughts on what went wrong in this case:

“This is a sad case of a surgeon normalising a bad treatment, the system not checking or investigating that treatment and it therefore going on unchecked. There is no official operation of a cleavage sparing mastectomy and the terms only relates to this case. However, when a mastectomy is performed most of the breast tissue is removed. You can never remove all of it but usually around 98% is removed. As some breast cells are left behind there is always a very small chance of further breast cancer. At the same time, if a surgeon makes the breast skin very thin in order to remove ‘as much as possible’ this is also not a good situation as the skin can sometimes die or when an implant is used there is no ‘padding’ to cover the implant and the cosmetic result will be poor.

“There is a balance between doing a full mastectomy but not taking more than is needed (i.e. leaving the natural fat under the skin). The surgeon in question has deliberately left breast tissue in the cleavage area to maximise coverage of an implant. This will reduce the palpability of implants, improve cosmetic results, and possibly even reduce infection rates. However, it is likely to increase cancer recurrent rates and is not recognised as any form of standard treatment. The actual risk of recurrence will not likely be that high but will likely be higher.

“This is a reminder that medical practice (and indeed many walks of life) should always be reviewed, as independent practice without proper audit and review can normalise what is bad practice from the beginning.”



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