A leading surgeon accused of causing grievous bodily harm to 10 patients may have carried out a series of "completely unnecessary" breast operations to earn extra money, a court has heard.

Ian Paterson lied to his alleged victims, "exaggerating or quite simply inventing risk of cancer", then often claimed payments for more expensive procedures.

And he did so for "obscure motives" which may have included a desire to "earn extra money", a jury of seven men and five women at Nottingham Crown Court was told.

His alleged victims included a 25-year-old woman who was left "devastated" when told unnecessary operations had profoundly affected her ability to breastfeed and a 42-year-old man who had a double mastectomy after being told he was "on the road to cancer" despite no evidence of malignancy.

The court heard another patient, 47-year-old Judith Conduit, was told by Paterson she may have a rare condition and underwent a double mastectomy in May and July 2001, the latter operation leaving her with problems which led to 94 hospital appointments in the following 12 months.

Paterson, 59, of Castle Mill Lane, Ashley, Altrincham, Greater Manchester, who was formerly employed by Heart of England NHS Trust and Spire Healthcare, denies 20 counts of wounding with intent against nine women and one man relating to procedures he carried out between 1997 and 2011.

Opening the case, Julian Christopher QC told the jury the charges relate to a period when Paterson was a busy surgeon with an "excellent bedside manner".

He said: "He was extremely experienced and knowledgeable in his field – breast surgery – which makes what happened in this case, the prosecution say, all the more extraordinary and outrageous.

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

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

Mr Christopher said the operations carried out by Paterson were ones which "no reasonable surgeon at the time would have considered justified".

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He said: "The principle issue in this case is likely to be whether (the patient) was harmed lawfully – or whether the prosecution are right that what Mr Paterson did fell quite outside the realms of reasonable surgery.

"Because firstly it was completely unnecessary and no reasonable surgeon would have carried it out.

"And because – the prosecution suggest – 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, whether to earn extra money by doing extra operations and follow up consultations, or because Mr Paterson enjoyed the responsibility that came with helping people."

Mr Christopher said: "In respect of many of the operations we are concerned with, when Mr Paterson put in his claim for payment, he had to indicate what operation he had carried out.

"Often the code under which he claimed his remuneration was for a slightly different – and more expensive – operation than the one which he actually carried out.

"Shocking though it may seem, the prosecution suggest the picture that emerges is Mr Paterson was lying to patients ... About the patient's condition, exaggerating or quite simply inventing risk of cancer in order to justify carrying out serious operations which were quite unnecessary."

He continued: "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."

The opening will continue on Wednesday and the trial is due to last up to 10 weeks.