A Glasgow-born NHS breast surgeon maliciously wounded private patients with unnecessary ops to earn him extra cash and maintain his successful reputation, a court has heard.

Cancer specialist Ian Paterson, 59, is also accused of lying to GPs and fudging medical results to justify putting his victims under the knife.

A court heard he "exaggerated or invented" risks of cancer, telling one man and nine women harmless lumps needed serious operations.

The consultant general surgeon is also accused of claiming payments for more expensive surgery than he actually carried out.

Paterson, of Altrincham, Greater Manchester, denies 20 counts of unlawfully and maliciously wounding ten patients between 1997 and 2011.

All charges relate to the doctor's private practice at Spire Healthcare hospitals in Parkway, Solihull and Little Aston in the West Midlands.

Paterson, dressed in a black suit and wearing spectacles, was accompanied by his daughter for his trial at Nottingham Crown Court yesterday.

Prosecutor Julian Christopher QC told the jury: "Mr Paterson was a busy surgeon with an excellent bedside manner.

"He was extremely experienced and knowledgeable in his field, which makes what happened in this case all the more extraordinary and outrageous.

"The 20 counts relate to individual operations which he told the patients were necessary, usually, but not always, on the basis that they had or were at risk of developing breast cancer.

"All of the operation the prosecution allege were in fact completely unnecessary.

"Remarkably and tragically these were operations which no reasonable surgeon at the time would have considered justified.

"Nor are we dealing with simple mistakes or incompetence. Frequently he misrepresented the results of various tests carried out.

"Both when he first presented with a patient with a lump in her or his breast, making what he found seem more serious than in fact it was.

"And also afterwards, making it seem that it had been a good thing that the operation had been carried out or that there remained a residual risk, so justifying a suggestion that the patient could return.

"In other words, for check ups providing him with both a fee and further opportunities to recommend further treatment in the future.

"What Mr Paterson did fell quite outside the realms of reasonable surgery.

"Mr Paterson was carrying it out not because he thought it was in the best interests of the patient, but for his own, perhaps obscure, motives.

"Whether to maintain his image as a busy successful surgeon in great demand and at the top of his game, or to earn extra money by doing extra operations, or because he enjoyed the responsibility that came with helping people who believed that their lives were in his hands."

Mr Christopher said Paterson frequently charged payment for more expensive operations than the ones he had actually carried out.

He added: "Shocking though it may seem, Mr Paterson was lying to patients and to their GPs, and in some instances to a colleague as well, about the patient's condition.

"Exaggerating or quite simply inventing risks of cancer in order to justify carrying out serious operations which were quite unnecessary.

"As a result, those patients and their families lived for many years with the belief that they could be very ill, and underwent extensive, life-changing operations for no medically justifiable reason.

"Some have consequently developed serious mental health problems."

Mr Christopher said Dr Rosemary Platt, a GP, visited Paterson with a lump in her right breast but a mammogram suggested "no definite malignant cells" in 1997.

Her results were sent to expert Professor Elston, who recommended "clinical examination and mammography" every two years, but not surgery.

But Paterson wrote to Dr Platt's GP before hearing from Professor Elston and "overstated the original report considerably" to justify two operations.

Mr Christopher said: "The wide local excision would not have been justified even if there had been lobular cancer in situ present.

"In addition, having the drains removed after the axillary clearance was something which Dr Platt remembers as one of the most painful things she went through.

"It was carried out deliberately and intentionally by Mr Paterson and, by its very nature, caused really serious bodily harm - as he must have intended."

Mr Christopher said Paterson created a "heightened sense of anxiety" when Dr Platt returned with a lump in her right breast, wrongly advising a mastectomy.

He added: "On June 25, 2001 Dr Platt underwent a full mastectomy, and reconstruction: this was a six-hour operation, requiring blood transfusion and with painful after effects.

"All in all, Mr Paterson systematically time and time again misinterpreted Dr Platt's pathology results, thereby raising her anxiety.

"It is not at all surprising that she was apparently presenting with new concerns about possible lumps leading to excessive clinical visits and ultrasound examinations, and consenting to what in fact was a traumatic series of unnecessary operations."