The case of Williamson v East London & City Health Authority [1998] Lloyd's Law Reports Medical, illustrates that it is essential for the patient to be informed of the nature and extent of the proposed surgery. Here the court found that the Plaintiff consented to one form of treatment, but was given another more radical operation. The plaintiff was given silicone gel breast implants at the age of thirty in 1979 for cosmetic reasons.
In 1982 she underwent a closed capsulotomy on her left breast, and three years later a similar procedure on her right breast. In 1988 under general anaesthetic she underwent closed capsulotomies on both breasts, but over the next three years she experienced further hardening of the right breast, and in June 1992 she consulted a plastic surgeon, a Mr. Kemble who was employed by the first defendants. He recommended a closed capsulotomy and warned of a small risk that the implant might rupture during this procedure. This was carried out in December 1992, and as a result silicone gel leaked from the right breast implant into the surrounding tissue. The plaintiff complained but no further investigation was carried out by Mr. Kemble.
In August 1993 the plaintiff consulted a Mrs. Neill, a plastic surgeon who was employed by the second defendants. She noted that the plaintiff's right breast was lumpy with marked capsular contraction, and expressed the opinion that the right implant might be leaking. A mammogram was performed, and arrangements were made for the plaintiff to have an open capsulotomy, for the lumps to be excised and for the implant to be replaced. The plaintiff signed a consent form for these procedures.
On April 26th 1994, after the plaintiff's condition had deteriorated further, she was examined by Mrs. Neill just before surgery, and lumps were discovered in her right armpit and down her right arm. Mrs. Neill stated in evidence that she had explained to the plaintiff at this point that a more serious operation would now be necessary, and that she would have to remove most of her right breast and possibly also the underlying muscle, though she could remember whether she had used the word "mastectomy". She said that it was her understanding that then plaintiff had understood very clearly what was involved and had accepted the changed situation.
The plaintiff denied that there had been any such explanation or that she had consented to more radical surgery. She did not countersign the original consent form, signed in January 1994, which had been altered to read "Bilateral replacement. Breast prosthesis. Right subcutaneous mastectomy. Excision biopsy. Gland axilla........"
The defendants produced evidence that when she excised the right breast there were multiple granulomas, that she had never seen a worse case, and that there was no option but to perform a mastectomy. The underlying muscle also needed to be removed. Later, a consultant pathologist diagnosed silicone granuloma.
The judge found that the plaintiff had not consented to such extensive surgery as had been performed, because on the balance of probabilities Mrs. Neill had not explained adequately her intention to perform a very different operation to that which had been considered appropriate originally. He found that the plaintiff was entitled to an award for of £20,000 for the injury suffered as a consequence of the "negligent" failure to acquire consent to the operation in question.
Report from the Independent Review Group for Silicon Gel Breast Implants.
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