A surgeon accused of carrying out unnecessary operations never told a patient she risked carrying a "ticking time bomb" of cancer in her breast, a court has heard.

Ian Paterson, who prosecutors have alleged wrongly carried out a mastectomy on Patricia Welch, said biopsies had uncovered "four risk factors" of the disease.

But the 59-year-old surgeon said he had never told Mrs Welch, then 48, she had a "ticking bomb" in her left breast as had been claimed, before the operation to remove both breasts.

Giving evidence in his defence at Nottingham Crown Court on Wednesday: "This is where Mrs Welch said the ticking time bomb analogy.

"I've never used that analogy in my life, it is a frightening analogy."

He is standing trial after denying 20 counts of wounding with intent against nine women and one man relating to procedures he carried out between 1997 and 2011.

Jurors have previously heard claims he carried out completely unnecessary operations for "obscure motives" which may have included a desire to "earn extra money".

Other alleged victims have included a mother who is said to have agreed to two "unnecessary operations" leaving her unable to breastfeed and a woman who had a "significant deformity in her visible cleavage area" after a pair of unneeded operations on her left breast, the court heard.

At the time of the operation Mrs Welch, was undergoing six-monthly check-ups at the Little Aston Hospital, West Midlands, after being told pre-cancerous cells had been found.

Paterson said he had given Mrs Welch and her husband Michael Welch all the options, ranging from continuing surveillance of the left breast to a double mastectomy.

Following a biopsy earlier in 2001, he said the pathology report was clear, adding it "gave us four risk factors in her breast".

He added: "So now, she has four cancer markers in her left breast.

Continuing his testimony, he told jurors that after the successful mastectomy in May 2001, tests on the removed tissue had revealed Mrs Welch had one "unstable breast", while the other seemed unaffected.

The surgeon said: "It's an unstable breast, it had a variety of risk factors and the conclusion of the pathological specimen because there's a background of breast disease.

"This whole breast is active.

"It's interesting to then compare it to the other information from the other breast - which is completely silent."

Paterson, of Castle Mill Lane, Ashley, Altrincham, Greater Manchester, who was formerly employed by Heart of England NHS Trust and also practised at Spire Healthcare, denies 20 counts of wounding with intent.