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Being overweight not only impacts one’s appearance but it can also negatively affect one’s health, depending on the extent of obesity. As the degree of being overweight increases, it is no secret that there are greater risks for having or developing medical and physical problems.

What may not be known as much is that obesity is also associated with both increased surgical and anesthetic risks. Short and long term results can be significantly impacted.

FTM and FTN top surgery are no exceptions to this association. Consequently, weight and, more specifically, BMI must be taken into consideration when top surgery is being considered. This includes issues, risks, complications and outcomes.

Based on all this, you may wonder if there are any weight or BMI restrictions that can impact your ability to have FTM or FTN top surgery.

Let’s investigate this further.

Weight and BMI

Weight can be a useful number or guide but it only conveys relatively limited information. For example, if a person weighs 170 lbs., are they overweight, underweight or are at a desirable weight?

With just this information, you can’t definitively answer this. You can only make a guess.

Adding the parameter of height to the weight can provide far more relevant and useful information including risks. That is the basis of BMI (body mass index) – a specific ratio of a person’s weight to their height. The calculated result can well quantify the level of “fatness” – underweight, normal, overweight, obese and morbidly obese.

So, for this above individual weighing 170 pounds, a 5 foot person would be obese, a 5 foot 10 inch person would be at a normal weight and a 6 foot 9 inch person would be underweight.

Here is the categorization of BMI levels:

Underweight = <18.5
Normal weight = 18.5 to 24.9
Overweight = 25 to 29.9
Obese = 30 to 39.9
Morbidly obese = 40 and greater

For more information on this or to calculate your own BMI, go to Calculate Your Body Mass Index.

General Reasons for Concern with a High BMI

A higher BMI is associated with an increased risk of developing numerous undesirable medical problems. These issues can affect your life, the quality of your life and even your life expectancy. They can also potentially impact your top surgery if you already have developed one of these medical issues caused by obesity.

Though there is no magic number or level where all of a sudden your risks will be markedly increased, having a BMI in the obese range, 30 and higher, does put you at greater risk. At a BMI of 40 and above, where one is considered to be morbidly obese, these risks are considered to be substantially increased.

Some of these issues and risks associated with a high BMI include:

Surgical and Anesthetic Risks and Outcomes Associated with a High BMI

A higher BMI is associated with increased surgical and anesthetic risks for individuals seeking FTM or FTN top surgery. This can be substantially problematic with a BMI of 40 and above even when additional precautions are taken.

Some of these risks include:

Clearly, you want to avoid or at least reduce the risks of having to deal with one or more of these issues when having your top surgery.

Plastic Surgeon Imposed Restrictions

Because of these substantially elevated risks for surgical and anesthetic problems for those individuals with a high BMI seeking FTM or FTN top surgery, many plastic surgeons will not operate based on a specific BMI alone. Of course, they always reserve the right to not operate on someone based on a constellation of risks or issues, independent of the BMI.

This same approach applies to other plastic surgery procedures as well.

The BMI number used varies among plastic surgeons performing these procedures. It can be 40 and above, 35 and above or even lower.

BMI Restrictions of Outpatient Surgery Centers and Hospitals

Some surgery outpatient centers or in office surgical facilities do restrict the performance of any surgical procedure on those individuals with a BMI of 40 or more. In such situations, the alternative would be to have the procedure done in a hospital. However, this does potentially introduce other risks and issues, including costs, which also need to be considered.

Do Insurance Companies Restrict Coverage of FTM and FTN Top Surgery Based on BMI?

We have contacted numerous insurance companies about having to meet any specific BMI criteria in order for a patient to obtain approval for coverage for their top surgery. At this time, none of them had any restrictions in place. This list included the largest insurance companies like Blue Cross Blue Shield, United Healthcare, Aetna and Cigna.

This could, of course, change with time.

The Bottom Line on Weight/BMI and Undergoing FTM and FTN Top Surgery

It is absolutely in your best interests to have your BMI in a healthy range, if at all possible. This applies to your general health as well as when considering FTM of FTN top surgery.

Unfortunately, and for many reasons, not everyone is or can be in a relatively healthy range. That is just reality.

When it comes to seeking gender affirming top surgery, a reputable board certified plastic surgeon (certified by the American Board of Plastic Surgery), will use their expertise and experiences to determine if surgery, at least at present, is in your best interests and is a prudent, relatively safe choice. This will be a decision based on your BMI along with other factors.

If an undesirably high BMI is the reason for not recommending surgery at the time, weight loss of a prescribed amount may allow you to turn your desire for top surgery ultimately into a reality.

Contact Dr. Turkeltaub

To schedule your consultation with me, Dr. Steven Turkeltaub, for gender affirming top surgery, please call the Arizona Center for Aesthetic Plastic Surgery at (480) 451-3000 or contact us by email.

Steven H. Turkeltaub, M.D. P.C.
Scottsdale and Phoenix, Arizona


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