It would be “crazy” to leave breast tissue behind during a mastectomy, a disgraced breast surgeon has told an inquest into the death of one of his patients.

Ian Paterson was jailed for 20 years in 2017 for wounding 10 patients, by carrying out an unauthorised procedure which left behind tissue.

New inquests are investigating the deaths of 62 patients, including 63-year-old Elaine Turbill in 2017, 12 years after Paterson performed a mastectomy.

Giving evidence remotely from prison, he claimed it was not him who coined the term “cleavage-sparing mastectomy” and said it was the phrase that had “caused the hysteria”.

Speaking in general terms, he told the inquest that breast surgeons aimed to remove all breast tissue when carrying out mastectomies, but in practice this was never 100% successful.

He said it was possible in some patients to leave thicker flaps, but that did not mean leaving breast tissue behind.

The inquest previously heard that when examined in 2010, Elaine Turbill had 20% of her breast tissue left behind by Paterson.

But he said it was “not an objective measure” and told the inquest when carrying out operations of this type he was “as near as possible certain that I wasn’t leaving behind glandular breast tissue”.

He asked why the residual tissue in Ms Turbill had not been noticed before that point and suggested it may have been fat which had grown since the operation in 2005.

He told the inquest he had discussed the possibility of a cosmetic reconstructive surgery with her, but she had rejected it.

He said there had been a delay in getting biopsy results for Ms Turbill, which he said was because of a shortage of trained staff and staff-leave.

He said: “She felt I think that she’d had a delay already,” and just wanted the tumour removed.

Paterson said it was not normally his practice to discuss the specifics of operations in great detail with his patients, because he believed it scared them.

Instead, he said he left those conversations to nurses.

The operation he carried out on Ms Turbill has since been described as a “cleavage-sparing” procedure, but Paterson said he was not aware of it being anything unusual at the time.

He said his motivation was to remove cancers, but he would try to leave as much as he could, safely, if “it was possible to give them a better cosmetic result”.

Paterson, who practised as a consultant surgeon from 1998 until 2011, treated patients at Solihull Hospital, then part of Heart of England Foundation NHS Trust.

He also practised privately at Parkway hospitals in Solihull and Little Aston in Sutton Coldfield, both run by Bupa until 2007 and afterwards by Spire.

The inquest heard another surgeon, Andrew Stockdale, had raised concerns about the amount of residual tissue left behind in mastectomy operations carried out at the Heart of England NHS Foundation Trust, where both worked.

Paterson said he was aware his colleague had been collecting evidence of this, but that the matter had not been raised within multi-disciplinary team meetings, which brought together NHS colleagues to discuss a patient’s treatment.

One of his colleagues, radiologist Dr Chris Fletcher, told the inquest on Wednesday that the breast surgeon was a “nightmare” to work with and that multi-disciplinary meetings were “always difficult” because Paterson “always tried to run the show”.

The inquest continues.