A breast surgeon accused of carrying out unnecessary operations has told a court there is always a "spectrum" of medical opinion on how best to treat cancer.
Ian Paterson said just as there were "shades of grey" in how potentially pre-cancerous cells were dealt with, so there were differences in how surgeons treated different patients.
Under cross-examination at Nottingham Crown Court on Monday, he said: "Medical opinion has that spectrum of activity.
"There are minimalists, there are the middle-grounders, and there are the radicalists."
The court also heard key clinical notes had been shredded, while others were "missing".
Paterson 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".
The jury have heard prosecution expert evidence from two consultants, who claimed a different approach could have been adopted to Paterson's alleged victims.
But the 59-year-old said it was unfair to judge his work by doing "a paper exercise".
He said: "To be honest I don't disagree with most of what they've said, but it's important to say and remember that these experts in this case conducted a paper exercise."
The surgeon, of Castle Mill Lane, Ashley, Altrincham, Greater Manchester, was formerly employed by Heart of England NHS Trust and also practised at Spire Healthcare.
Paterson also told how copies of clinical meeting to discuss a second opinion for patients would be shredded.
In earlier evidence he had described the lack of records of what were known as MDT (multi-disciplinary team) meetings as "frustrating".
But on Monday, he told jurors there was "no need" to keep his own copy as they formed part of the patient's own final consultation notes.
Julian Christopher QC, prosecuting, asked: "So you then bring the fruits of that second opinion back to the private hospital - and then you shred it?"
Paterson replied: "Or rip it up, there's no need to retain it."
In the time before minuting meetings became more formalised, Paterson said a nurse would make notes in a diary.
However, he said they also "seem to have gone missing".
Paterson said it was "untrue" to suggest the notes had simply never existed.
The surgeon was asked about what the Crown claimed was the "entirely disproportionate" operation on one of Paterson's alleged victims, Leanne Joseph, in October 2006.
In her own evidence, Mrs Joseph claimed she only opted for surgery because she alleged Paterson told her she risked having pre-cancerous cells.
Mr Christopher put it to Paterson that much of the contents of his letters to patients' GPs were "untrue", but the surgeon replied: "What is in the letters, is what I did."
The prosecuting barrister then took him through Mrs Joseph's GP letter where Paterson had stated that a scan showed that her breast ducts were "rather dilated", when the scan itself stated they were "not dilated".
Mr Christopher asked: "It's a lie isn't it?"
But Paterson replied: "No, it isn't a lie."
He also denied misrepresenting patients' test results to dupe insurers into paying for surgery.
Paterson repeatedly told jurors he had never told Mrs Joseph she had pre-cancerous cells.
However, he then told jurors the "bleeding from the nipple" she was suffering could have been a sign of pre-malignancy.
Mr Christopher asked him: "But you told us, not only had you not said (to her) this was pre-cancerous, but that there would be no reason to say it."
The trial continues.
The hearing was adjourned until Tuesday.
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