Trans people who are obese are being denied gender-affirming surgeries because of their size, it has been revealed.
Surgeons in the US have been refusing to carry out ‘top’ surgeries — removing the breasts — on the patients, fearing they are at higher risk of complications and because of slower healing times.
Patients also claim doctors have refused surgeries saying they would not be happy with the results and due to bias against fat people.
But some surgeons are now calling for this barrier to be removed, pointing out that it can leave vulnerable patients at risk of mental health problems and that there is little evidence these individuals are at greater risk of serious complications.
Patients affected by surgeons’ refusals include Vince Wescott, 32, from North Carolina, who was told to lose 100lbs before he could be considered for top surgery.
Surgeons in the US have been refusing to carry out ‘top’ surgeries on patients who are obese, saying they are at higher risk of complications (stock photo)
About 60 percent of people who identify as transgender are overweight or obese, according to estimates from the National Institutes of Health.
Some 25 percent of these will come forward for ‘top’ surgery, of which about 14 percent will be denied — often because of their weight.
Guidelines from top medical bodies do not suggest limiting ‘top’ surgery based on someone’s body mass index (BMI), but many clinics have still brought in the limits.
Arguments for this include a perceived higher risk of infection in obese patients and slower healing times because the extra weight strains their body’s systems.
There are also suggestions that patients will not like the results, because the excess adipose tissue in the chest area can impact the aesthetic outcomes.
Surgeons may also face technical difficulties, including in contouring the chest and gaining access to the mammary tissue that is to be removed.
But other surgeons have argued against this position, pointing out that obese patients are no more at risk of prolonged hospital stays or returning to hospital than their counterparts of a healthy weight.
A study carried out into the risks of ‘top’ surgery in 2021 by Georgetown University, based in Washington DC, found that obese patients faced no greater risk of major complications — requiring a return to hospital — than their healthy peers.
But they were more likely to face minor complications, at a rate of 31.5 percent compared to 12 percent for patients who were a normal weight.
These included infections, hematoma (or the accumulation of fluid), and aesthetic problems, such as nipple graft loss and dog ears — where excess skin or fat puckers at the end of an incision.
Dr Gabriel Del Corral, a plastic surgeon and lead author of the study, told STAT News: ‘You have caused a tremendous improvement in this patient’s dysphoria and mental well-being in exchange for having perhaps a small area of a nipple graft that eventually will heal.
‘If I put that to most surgeons and most patients, I think everybody will deem that as an acceptable risk.’
Patients who have been affected by surgeons’ refusal to carry out the surgery include Mr Wescott from North Carolina. He had saved up the cash, gotten a letter from his therapist and sent in the required photos for the surgery — but was initially denied it because he is obese.
Patients who have been declined ‘top’ surgery because of their size include Azrael Dean Martinez (pictured)
‘The doctor had a look at the pictures and your weight is very concerning,’ he remembers a nurse saying. ‘He is not going to be able to do this unless you lose about 100 pounds.’
‘It was like getting hit by a train,’ Mr Wescott said, reacting to the moment. ‘It took everything out of me, I really didn’t want to live at that point.’
Another patient to face the same issue was Azrael Dean Martinez, 40, who was also denied top surgery during their consultation and instead pushed to lose weight.
They accused the medic of judging them for their size, saying they remembered the doctor saying: ‘I refuse to do anybody at your weight because you won’t be happy with the results.’
They added: ‘It felt like talking to a wall. I felt body shamed.’
But some surgeons are now coming forward to offer the top surgery to obese individuals, saying the benefits outweigh the risks.
They include Dr Loren Schechter, a surgeon at Rush University Medical Center in Chicago, Illinois, whose practice has dropped its weight restrictions.
In the end, Mr Wescott was able to get ‘top’ surgery after seeing an Instagram post from a clinic saying it was willing to do the surgery on larger individuals.
He did develop an infection after the surgery but blamed that on the 12-hour drive back from Florida to North Carolina, where he accidentally opened up a wound.
It comes as many Republican-led states seek to crack down on ‘top’ surgery being offered to minors.
They argue that the individuals are still too young to make an irreversible change to their bodies.
But others have hit back at the legislation, saying that it is only a very small minority who get top surgery this early.