A breast surgeon carried out "completely unnecessary" operations after inventing or exaggerating cancer risks, a court has heard.
Ian Paterson, 59, of Altrincham, denies 20 counts of wounding with intent against nine women and one man.
Prosecutor Julian Christopher QC said the patients "underwent extensive, life-changing operations for no medically justifiable reason".
Some of the patients developed mental health problems as a result, he said.
The procedures occurred at Heart of England NHS Trust and privately-run Spire Healthcare hospitals in the West Midlands.
Opening the case at Nottingham Crown Court, Mr Christopher said the charges related to a period between 1997 and 2011 when Mr Paterson was a busy surgeon with an "excellent bedside manner".
"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," he said.
"All of the operations, the prosecution allege, were in fact completely unnecessary," he told the jury.
Mr Christopher said the main issue of the case was 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".
He said the prosecution would suggest the surgeon carried out the operations "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," he said.
He told the jury Mr Paterson, of Castle Mill Lane, Ashley, may have "enjoyed the responsibility that came with helping people".
The court heard the details of three counts relating to Rosemary Platt, a GP referred to Mr Paterson in 1997, when she was 47, after finding a lump in her right breast.
Mr Paterson carried out two procedures on her, without waiting for a report by a specialist breast pathologist - which ultimately did not recommend any surgery, Mr Christopher said.
Dr Platt later had a full mastectomy and reconstruction after becoming worried about further lumps.
"All in all, Mr Paterson systematically misinterpreted time and time again Dr Platt's pathology results, thereby raising her anxiety, so that it is not 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."
'Unable to breastfeed'
Another patient, Leanne Joseph, 25, was left unable to breastfeed after unnecessary operations carried out by Mr Paterson, the court heard.
She was told by Mr Paterson she had pre-cancerous cells in her milk duct and was recommended for surgery two days later.
The court heard her scan had been "entirely normal" and that the operation and a similar one later were unnecessary.
Mr Christopher told jurors other victims included:
- Judith Conduit, 47, told by Mr Paterson she may have a rare condition. She underwent a double mastectomy, which left her with health problems, and 94 hospital appointments in 12 months
- A 42-year-old man who had a double mastectomy after being told he was "on the road to cancer". There was no evidence of malignancy, the court heard.
Mr Paterson's trial is expected to last 10 weeks.