In this case, doctors failed to obtain valid informed consent from our client, Rebecca, relating to reconstructive breast surgery she underwent after suffering from cancer.
In 2013, Rebecca attended her local hospital reporting pain in her right breast. She was diagnosed with malignant neoplasm of the right breast – a cancerous tumour. It was decided that the correct way to proceed was with a lumpectomy. A lumpectomy is a type of surgery that aims to remove cancer or other abnormal tissue from the breast. It is also referred to as breast-conserving surgery because — unlike a mastectomy — only a portion of the breast is removed.
The doctor informed Rachel that the plan was to proceed with the Benelli technique. The Benelli technique involves an incision around the outside of the areola, in a donut shape. It is supposed to leave the incision lines undetectable in underwear and swimwear. Rachel was not given any other options. The advantages and disadvantages were not discussed there was no offer of any alternative treatment. Furthermore, the possible outcomes and risks of such a procedure were not discussed in any detail.
Following the procedure, Rachel was heavily bandaged and did not see the results of the surgery until a few days later, when the dressings were changed. The nurse reassured Rachel that they would look completely different once the swelling had gone down. After a few weeks, fluid started to leak out and Rachel had to wear breast pads. She then noticed that the breast was starting to draw back, and there was wrinkling around the nipple. Rachel was shocked and upset, she was not expecting perfect breasts, but she equally did not expect the result to be so bad.
Rachel was told that the aesthetic issues could not be addressed until she had completed chemotherapy and radiotherapy. Once the oncologist was happy there were no signs of reoccurrence, Rachel was scheduled to have further surgery on her right breast. The doctor suggested lipomodelling – a procedure that uses liposuction techniques to improve the contour of a breast after reconstruction. The doctor discussed the usual risks with her, including infection and bleeding, before taking photographs.
Although there was some improvement with the right breast after the operation, it was still clearly distorted. Additionally, the left breast had been operated on for no reason and was now scarred. Rachel was devastated, as she had at least hoped they would look a similar size when dressed. She was also in a great deal of pain following the operation – in both her breasts and abdomen, which was black from bruising as this is where the surgeon had harvested the fat for the liposuction.
Rachel attended another appointment but was eventually told that the surgeon could not do anything to help reconstruct the breast. The whole experience had a significant impact on her life, and her relationships with others. Rachel had always been a very outgoing and sociable person, but now struggled to leave the house, and was very self-conscious about her body. She said she had lost all confidence in herself, so was prescribed anti-depressants by her GP
Pryers were able to prove that the performing surgeon failed to ensure Rebecca was aware of reasonable alternatives to the surgery and to inform her of the risk that there may be a circumferential tight band around the areola from the purse tightening and that there would be skin wrinkling. As a result, Rebecca was left with a severely disfigured right breast, had to undergo an unnecessary operation she still requires further surgery to correct the disfigurement and her mental health has suffered significantly as a result.
The case was eventually settled for £47,000.