Poor experience - Mr John Murphy, Spire Manchester

Mr John Murphy, Spire Manchester - bilateral implant removal, capsulectomy, mastopexy and fat transfer.

I had a poor experience for main 2 reasons. Mr John Murphy agreed to a total capsulectomy. He did not perform this. He removed a very small portion of the capsule for sampling only. Secondly, I had a poor cosmetic result that required extensive revision surgery (new surgeon).

Total Capsulectomy

The implants had been in place for 18 years. I had experienced problems with the R breast (late seroma, chronic pain, capsular contracture ). I had an MRI to check for rupture but the implants were intact. I had also developed a serious autoimmune condition 5 years before. I was advised by the NHS surgeon seen before Mr Murphy to explant and not replace the implants. A possible link to my autoimmune condition was queried. I was told by the NHS surgeon I should have a total capsulectomy because of the previous BIA ALCL concern (late seroma), and to give the best chance of my autoimmune condition improving (remove all capsule that may contain silicone and is causing the immune system to react).

I initially met with Miss Lyndsey Highton for a consult. She has excellent reviews. However, her anaesthetist was not happy to proceed at Spire Manchester due to my autoimmune medical condition. Miss Highton recommended Mr John Murphy.

Preop I met with Mr John Murphy briefly for one 15 minute consultation. I gave him the clinic letter from Miss Highton and all the NHS clinic letters I had obtained so he was fully aware of my history. Her letter mentioned that I had been told it was possible my implants were contributing to my autoimmune condition, that I have had episodes of R breast swelling and seroma, that settled spontaneously but that I still have more discomfort on the R side. In her letter she also describes mild capsular contracture on the R side and a waterfall effect on both breasts with the tissue sitting lower than the implants. I also provided details of the type of implant (650CC Mentor textured high profile) and registration details.

I told Mr JM that I had initially wanted my implants replaced and a mastopexy, but that I had been informed that I was no longer a suitable candidate for breast implants and also that the implants may have been contributing to my autoimmune disorder. The seroma and R breast pain coincided with the start of my symptoms. I said I had been told by surgeons that there could be a link and that I should have the implants removed and not replaced and total capsulectomy was indicated. As I was having the implants removed for health reasons and not replaced, I asked Mr JM for a total capsulectomy. The recent MRI had shown the implants were intact so enbloc was not required. Mr JM seemed to agree to this. He did not raise any possibility of a partial capsulectomy or instances when he would not be able to perform a total capsulectomy. He did not ask if the implants were subglandular, subpectoral, dual plane etc. It was very important to me that a total capsulectomy was performed. If there was a chance removing my implants and capsules could help improve my symptoms, I wanted to try. Silicone in the capsule can play a role in activating the immune system and studies show patients with autoimmune disorders have better health outcomes if a total capsulectomy is performed. Retained capsule can also form capsular masses, requiring further investigation or surgery.

I was briefly examined and measured. We discussed fat transfer as I was concerned how flat I would be without implants. He said he could get 300ml fat in each side with a retention of 70% giving me a probable C cup. I said that would be fine. I had given him a list of my medication and asked if my medication would affect fat retention. He said he didn’t think so. I asked if I would need more than one operation. He said no, only if I wanted to be bigger. He did not mention that repeated fat transfers could be needed or that there could be volume asymmetry as a result of the fat transfer. He said PICO dressings would be placed post op, not drains. He did not mention any complications of the use of PICO dressings. I asked if I needed to be seen again for a further clinic appointment before surgery. He said no. He gave a possible surgery date of 4 weeks later and told me to follow up with his secretary. I was not shown any photos of previous patients results. Mr JM does not have a website or any online presence to recommend him. I went ahead despite reservations due to the brief consultation because he had been recommended by Miss L Highton. I also thought it would be ok because I had provided him all the information I had.

When following up with his secretary, Zoe, by telephone, I again checked that he intended to perform a total capsulectomy. I asked if this was specified in the price I had been quoted. She said she thought he normally did this procedure as standard when removing implants, but that she would check with him. She replied by email that he would be performing a capsulectomy –‘ Mr Murphy will remove the capsules at the time of your surgery’.

I was consented for the procedure immediately before surgery by Mr JM. I was first up for surgery so the process was quite rushed. There was no chaperone present. He was in the room less than 5 minutes to take clinical photographs, mark me up and get my signature on the consent form. I was not given the opportunity to read the consent form. I was told by Mr JM that ‘I didn’t need to read it as it was pretty standard stuff apart from the part on free nipple grafting if my nipple didn’t like being moved’. He gave me the form whilst I was still stripped to the waist. I signed it quickly where he indicated. I was not given a copy of the consent form. I asked again if I would need more than one operation. He said no, only if I wanted to be bigger.

He did not discuss the surgical plan, clarify what he would be doing, nor mention any complications that could arise. He spoke only generally of the how fat transfer had been developed within the NHS as a reconstructive technique.

Weeks later I read the consent form when I requested my medical notes from Spire Manchester. The consent form said ‘partial capsulectomy’ under procedures to be performed. If I had read this I would not have gone ahead with the surgery under Mr JM. It appears he intended to perform a partial capsulectomy from the start but did not inform me of this. This was not what I had asked for, nor what I had been told was indicated by my history of breast implant issues and autoimmune disorder. Despite being provided details of my breast history, I do not believe he read these or he would not have planned a partial capsulectomy.

I asked in HDU as soon as I was conscious if the capsules had been removed. HDU nurse, Jane read from my notes, partial capsulectomy as no history of breast implant illness. The doctor that checked up on me in HDU also read the same information from my notes, adding the posterior capsule was left in place, the anterior portion removed. I cannot find this in my medical notes now. If it was present, it would indicate my medical history was overlooked as this is not true.

When I asked Mr JM 3 weeks post op about the partial capsulectomy performed, he said it was because the implants were both in dual plane pockets. He said he would not have agreed to a total capsulectomy if he had known this as it makes the capsule removal more risky. He had mentioned a waterfall effect and a muscle repair in the clinic appointment so he must have considered this placement. He had not asked me pre –op if I knew how the implants were placed. He had not mentioned this as a factor that could influence if he would remove the capsules fully. He said he had not wished to risk a pneumothorax and that the capsules were very thin. I had had a capsular contracture on the R side so I was unsure if this was true as CC is normally associated with a thickened capsule. He said he had removed ‘the majority of the capsules’, that the remainder would break down over time and that there was no BIA ALCL on the portion submitted for histological testing, only chronic inflammation. I was very disappointed as I had been told I would have the best chance of a positive outcome from the implant removal with regards to my autoimmune condition, with a total capsulectomy. Further, as I later found ‘partial capsulectomy’ was indicated on the consent form – it was unlikely he performed a partial capsulectomy because of finding dual plane placement, if he had intended it preop.

When I was seen by another surgeon for a second opinion 6 months post op (Miss Oni, Spire Nottingham), she palpated a painful lump in the upper pole of the L breast, above the nipple. I was told it was possible fat necrosis from the breast fat transfer. I had an USS and was told to monitor the lump until removal.

When I had revision surgery after 9 months with another breast surgeon, he said the lump was a portion of capsule encapsulated by the body. Post op he said that ‘ it was a real mess in there. Most of the capsule was still in there’. At my post op check I asked about this. He said he removed a 7 x7cm piece and a 7x 4cm piece that were sent for testing. He said he had removed all the other remaining capsule pieces. My new surgeon is a breast surgeon, like Mr JM, but he was able to remove all the capsule, seemingly without risk of incident such as pneumothorax. I now do not have to worry about the capsule pieces creating further lumps, simulating suspected masses and requiring further surgery to remove.

Poor Cosmetic Outcome

Preop, I had textured Mentor 650CC HP implants. I did not have a noticeable difference in breast volume. I had a capsular contracture on the R side, leaving the implant slightly higher. The nipple was slightly lower on the R side.

The preop marking by Mr JM was very brief (<2 minutes) and imprecise. A freehand line drawn down the centre of my chest and 2 height marks made above my nipples. I asked that he not make my nipples too high. I asked if he would reduce the size of the nipples. He coloured them in smaller than the areola in black.

Mr JM stated in the preop clinic letter that the op (bilateral implant removal, capsulectomy, mastopexy, fat transfer) takes 3-3.5 hours to perform. I was in surgery for a considerably shorter time – 2 hours 15 minutes. Surgeons seen post op were surprised by this. It was queried if Mr Murphy's surgical assistant had performed contralateral surgery. I was not consented to this.

In the HDU post op 16/5/23 and 17/5/23, each member of staff asked me why I chose Mr JM as my surgeon. 4 nurses, 2 anaesthetists, and a doctor. I eventually asked Ivelina, the HDU nurse who had looked after me overnight why everyone asked the same question. She stopped and looked at me. She said ‘he operates a lot, never says no to patients, but he is not a perfectionist…unlike the plastic surgeon I used to work for (Mr Sohail Aktar)’. I asked her if my breasts looked symmetrical. She said ‘mostly’. Another nurse described his surgery as 'conveyor belt surgery'.

I brushed this off and I had a 1/7 check up with Stella Ward 23/5/23. She was meeting me for the first time. I had had problems with the bilateral PICO devices placed buzzing. They were still indicating green but the continuous buzzing suggested an air leak. Stella removed the PICO dressings from the wounds and replaced them, also replacing the PICO machines with 14 day versions instead of the 7 day versions I had. She did not have my medical notes present. She said this was common when patients had been on HDU. I told her what procedures I had undergone, but found she had not picked up on the fact I had not had implants replaced. At the end of replacing the dressings, she had checked that I had new implants and I had to tell her no. She had offered to show me the result before she replaced the dressings but I said I would wait until 2/7 when they were removed. She said I was healing well and things were looking good. The process of replacing the PICO dressings took almost an hour and considerable pressure to smooth them down to get an airlock.
I was subsequently told by another nurse it was a breach of duty to remove and replace the PICO dressings without instruction or my medical notes present. Stella added a later insert to my Spire medical notes that she replaced the PICO devices. She omitted from my notes that she removed and replaced the PICO dressings as well as the attached devices.
2/7 check, PICOs removed by Stella Ward. I sat up and immediately noticed that my R nipple has very small and high, close to my armpit. I could see the entire R nipple from above as it was so high, rather than just the upper portion of the L nipple. I mentioned the small size to Stella – she said it was proportional to my new smaller breasts. She said I needed to let the breasts settle and hurried me into a bra. She did not give me the opportunity to view the result, or warn me of the asymmetry.

I returned home (2.5 hour journey) and viewed the result for the first time without the large PICO dressings. The R nipple was half the width of the L (nipple less than 2cm), the R nipple was very high on the breast and very lateral, almost in the armpit. The vertical incision was 7cm on the L, 11cm on the R. There was caving in to the lateral side of the L breast. I had lost a lot of fat in the L breast around day 10. Both IMFs were very low and loose. There was very marked asymmetry of 4cm difference in nipple height. The IMF incision on the L side was straight, not curved as on the R. There was a scar to the mid lateral section of the R breast. The stitching was uneven with surgical glue in incision gaps between stitches. There was volume asymmetry with the L considerably smaller.

I called Spire Manchester and left a message for Stella, and she called me back. I expressed upset at the result. She said PICOs could cause temporary asymmetry and that it would settle. I expressed doubt but agreed to seeing Mr JM sooner at 3 weeks post op.
At the 3 week post op clinic appointment, Mr JM was adamant that it was a good cosmetic result, with good volume asymmetry. I showed him the breast prosthesis I was wearing in the L side of my padded post op bra to appear normal in clothing. He dismissed this. He said breasts aren’t symmetrical in nature and that the problem was my expectations. He had not informed me of the possibility of asymmetry in shape or volume. He said I had been symmetrical in surgery when he had finished. He said the asymmetry had been caused by the application of PICOs in surgery or by Stella reapplying them 1/7 post op. He said this had caused the difference in nipple height, vertical incision length and in nipple size. He had not previously told me that the use of PICO’s could cause asymmetry and the need for further corrective surgery. He said he thought I was meant to be grateful he had taken me on as a patient.

Despite the 4cm measurable difference vertical incision length, he said there was only a slight height difference of 0.5cm. I showed him a photo I had taken that morning that clearly showed the differences. He said all he would be willing to do was a crescent lift of the L nipple to match the higher R nipple, under local anaesthetic. I said the R was too high so I didn’t want both nipples too high. He said he could not see a difference in breast volume and that 9/10 people shown a photo of my breasts would say they were the same size. Mr JM wrote to my GP (not copied to me) that post op I now had very good volume symmetry (despite over a cup size difference, L smaller) and a 0.5cm difference in nipple height (not 4cm), also wrongly stating the L as higher. He said there was a disconnect between what is symmetrical and what I felt is symmetrical.

8 weeks post op I was seen again by Mr JM and Stella. He agreed that there was some persisting asymmetry in shape and size and that he would be willing to reduce the longer vertical incision of the R breast. He said this had lengthened and bottomed out. I said at 11cm, it was the same as when the dressings were removed 2/7. He said he would also add fat to the L breast to correct the volume asymmetry and would ask the hospital to fund both as a complication. It was a marked turnaround in opinion and demeanour. He said I would need a second opinion from a colleague to determine if the hospital would fund the revision. He again wrote to my GP (not copied to me) that I had a 0.5cm nipple height difference and overall excellence shape and symmetry.

9 weeks post op I was seen by Mr James Murphy at Spire Manchester for a second opinion. He did not have my clinical notes present so I could not ask about the procedure performed. He took clinical photos and a 3D Scan. The 3D scan showed volume difference of 120ml (L smaller). He denied the asymmetry was caused by the PICOs as stated by Mr JM. He said it was how I was measured and sewn up. He said the R nipple was so small despite 4.2cm nipple cutter guides having been used because it had been sewn into too small an incision. He drew diagrams to illustrate this. He disagreed with Mr JM that asymmetry will settle itself in time. He said he would repeat the mastopexy on the L side and add fat, and reduce the length of the vertical incision on the R side. He said I had good skin quality, better than a lot of his implant removal patients. He informed me he was leaving Spire Manchester, which I was not aware of. I asked if he would perform the revision in his new hospital as I had lost confidence in Mr JM. He said he would speak to his anaesthetist and consider it, and booked me in for a further consultation after the move (The Pines, Transform). I was subsequently informed by patient services that Mr James Murphy would be unwilling to perform the revision at his new hospital (no HDU), nor return to Spire Manchester to perform it.

I was offered the option of Miss L Highton or Miss O Ceallaigh by Spire patient experience to discuss revision surgery. I agreed to Miss Highton but was told she was not willing to take on the case. I agreed to see Miss S O’Ceallaigh, despite concerns as a close colleague of Mr JM, she may not give an unbiased opinion. I asked Rachel Bond for the photos taken by Mr James Murphy to be provided to Miss O Ceallaigh as they clearly demonstrated the asymmetries. I was told the 3D scan would be sent but the clinical photos had been ‘lost’.

I saw Miss O’Ceallaigh 3.5 months post op at Spire Manchester. I told her how he had said he could get 300ml fat in with a retention of 70%, she rolled her eyes and said ‘he would’. I commented on how low my breasts were, considering I’d had a mastopexy. She said the IMFs were loose and low. She said Mr JM’s mastopexies ‘were normally stitched high on the chest wall’. I asked if she could repeat the mastopexy. She said she could not, she could only do what Mr JM had told her to do, a light touch revision. I asked if she could lift the IMF’s – she said no, it was too difficult. She was willing to reduce the length of the R vertical incision, raise the L nipple and repeat fat transfer to the L. I agreed to this and a surgery date was set.

She wrote to my GP (copied to me) with a clinic letter. In it she stated I could not be expected to retain the initial lift high on the chest wall due to poor skin quality, despite having herself said I had not had this. She also mentions bottoming out on the R side, despite this R breast appearance being the same as immediately post op. She also states that I should expect high rates of fat reabsorption due to my medication (steroids, methotrexate). I had asked Mr JM preop if they would affect fat transfer and he said no. Her clinic letter read as a defence of Mr JMs poor result. As a result, I asked to see her again preop to discuss. Miss O Ceallaigh revised what surgery she was willing to perform. She said she now felt the L nipple was not stretched out or too low, so she would not revise this. She said she would only reduce the length of the vertical R incision and add fat to the smaller L breast. She said she was not confident this would improve the appearance greatly but it was all she was willing to do. She subsequently wrote to my GP again (copied to me)stating that my areolae are now symmetrical and do not need revision, and that what she would be willing to do surgically would not meet my expectations, so she would no longer offer any revision surgery. My revision date was cancelled by email.

My case was now passed to Emma Ashton, patient services manager. She offered a 3 way meeting with Miss O’Ceallaigh to try to convince her to perform surgery. I said no, if she was unwilling I didn’t wish to force her. I was offered a further appointment with another colleague of Mr JM, Professor Ged Byrne. I had previously been told by Rachel Bond (patient services) that he was no longer operating regularly and there was no indication that he would perform the revision, neither Mr JM nor Spire had approached him. I decided to get an independent second opinion as I felt I had not been getting the truth from Mr JM or his colleagues.

I was seen by Mr D Macmillan at the Park Hospital 6 months post op. He took clinical photos and measurements and immediately commented on how low my breasts were. Without prompting he picked up on the nipple size and height asymmetry, lateral position of the R nipple and breast volume asymmetry. He felt a full revision mastopexy was required, lifting the IMFs and stitching higher on the chest wall, revising all incisions, further fat grafting and bilateral LTAPs to improve the caving in on the L side and poor (high, lateral) nipple position on the R side.

Spire Manchester would not fund revision with Mr D Macmillan as although they accepted that I required revision surgery, they would only fund it in a Spire Hospital with HDU. The next closest was Spire Nottingham so I agreed to see Miss G Oni a week later for a further opinion. Miss Oni largely agreed with the opinion of Mr D Macmillan in terms of surgical revision required. She would perform LTAP/revision mastopexy in one operation and fat transfer separately. She also felt more than one session of fat transfer would be needed to fix the volume asymmetry. She informed me she was leaving Spire Nottingham and would only have time to perform one of the operations at most, before handing me on to another surgeon. She did not feel she knew of any other surgeon within Spire at a HDU hospital that could do the surgery she felt was needed (including LTAP). I did not want to have part of the surgery and then be handed onto another surgeon at Spire Nottingham.

After careful thought, I decided to go ahead with revision surgery with Mr D Macmillan 9 months post op. I had been offered 4 Spire surgeons and none were willing to take on the revision of Mr Murphy's work. I could have tried further Spire surgeons at hospitals further away, but I did not wish to travel any further for surgery, nor was there any guarantee any of them would take me on as a patient. I was also postponing medical treatment needed , waiting for revision surgery which I could not continue to do.

I was advised by members of staff at the Park Hospital to speak to a solicitor about the surgical outcome from Mr John Murphy. I did so and met with a plastic surgeon that offered an expert opinion on the outcome. I ultimately decided not to pursue legal action, but I did feed back the issues highlighted by the expert in the Mr Murphys's conduct and practice to Spire Manchester. An internal investigation is ongoing.