A surgeon joked about a husband helping to moisturise his wife's nipple after she was left wounded by an "unnecessary operation", a court heard.

Leanne Joseph, 36, said she went under the knife as she "didn't want to die" after experiencing discharge from her breast in 2006.

Ian Paterson is alleged to have said a scan revealed pre-cancerous cells, while the prosecution claim the results came back all clear.

The surgeon 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" that may have included a desire to "earn extra money".

After asking her parents for financial assistance for the operation, Mrs Joseph, who had recently got married, underwent the £1,500 procedure to remove her milk ducts carried out at Little Aston Hospital, Birmingham, in October 2006 by Paterson.

As she went to have her stitches taken out on her left breast, Paterson told her it was common for her condition to appear on both sides and she was advised to go under the knife again which she did at the same hospital two months later, the court heard.

During a follow-up appointment to check on progress, Paterson spoke of the need to moisturise the area to aid recovery.

Mrs Joseph told the court: "Mr Paterson made a very inappropriate remark saying it's something my husband could join in with."

When asked by prosecution QC Julian Christopher why she decided to have the first operation, she told the jury: "Because it was pre-cancerous and I just did not want to die."

The jury of seven men and five women have previously heard Mrs Joseph was told to take medication to prevent her from being able to breast feed following the operations.

The mother - aged 25 when she had the operations in 2006 - was left paranoid and developed OCD after later giving birth fearing for the immune system of her daughter, now aged eight.

Speaking about the impact of not being able to breastfeed, she said: "I found it very hard because all the other mums in the hospital were breastfeeding and there were posters everywhere telling you that breast milk was the best thing for your child's immune system."

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.