By Adele Robinson, Sky News Correspondent
A review into how a breast cancer surgeon was allowed to carry out incomplete mastectomies on hundreds of women has described the case as "depressingly familiar".
Ian Paterson performed unregulated "cleavage-sparing" procedures at Solihull Hospital and Good Hope Hospital in Sutton Coldfield, West Midlands, for 15 years.
The operation leaves breast tissue behind for cosmetic reasons and is against national guidelines.
The independent review, carried out by Sir Ian Kennedy, looked at how the Heart of England NHS Foundation Trust responded to concerns raised by staff and patients.
Ian Paterson was told to stop performing the operations after a 2007 review It found the trust missed a number of opportunities to stop Mr Paterson performing unauthorised surgical procedures.
"Lessons for the future cannot be learned unless the past is understood," Sir Ian said.
"The story is complex but the themes are depressingly familiar. The fundamental theme is one of culture. When culture fails, care fails.
"Concerns were expressed as early as 2003 but were not treated with sufficient seriousness, nor looked into with sufficient rigour and care."
Sir Ian Kennedy delivers the findings of his review He added: "Various colleagues in the breast unit raised concerns, an investigation was launched and a report produced ... but nothing came of it.
"Mr Paterson was not an easy colleague. He was not a team player. The focus of managers, however, was on man management when it should have been on Mr Paterson's surgical practices and competence."
An internal report carried out at Solihull Hospital in 2004 highlighted the potential risk of the procedure.
In 2007 there was a review of breast care services at the hospital and Mr Paterson was told to stop performing the operations.
Shirley Moroney's sister Marie Pinfield died following surgery However, there is evidence from solicitors suggesting he performed the procedure until 2010.
In his 165-page report, Sir Ian said the trust must "make its peace with patients, staff and the community".
"There is much anger and a strong sense of betrayal," he added.
Shirley Moroney's sister Marie Pinfield was operated on twice by Mr Paterson in 2006 and on both occasions he left breast tissue behind.
The NHS Trust said negligent surgery did not cause Ms Pinfield's death Ms Pinfield died two years later but the NHS Trust says negligent surgery did not cause her death and her cancer would have returned even with a full mastectomy.
Ms Moroney believes Mr Paterson had too much power.
"I'd like a cultural change within the NHS that meant that if people were concerned about the way operations were being done that they could have a voice," she said.
"No-one ever questioned him and that's why he was allowed to get away with it as long as he did."
Lord Philip Hunt, chairman of the Heart of England NHS Foundation Trust, said: "I wish to give a full and unreserved apology to all of the patients and their relatives for the way in which they were mistreated by Mr Paterson ... and also how they were subsequently let down by the trust management team at the time in their failure to properly intervene into his practices and his behaviour in terms of patient safety and quality of care.
"This was completely unacceptable and I'm very sorry indeed."
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