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There has been some concern lately from prospective female to male patients about weight limitations for surgery. Most of the concerns relate to top surgery, but body weight is also a consideration for bottom surgery. Surgery often involves several hours of general anesthesia. The most important consideration is the health of the patient, regardless of weight. Factors other than weight, such as hypertension, heart disease, diabetes, kidney disease, and various systemic diseases come into play in the decision making process. If these conditions are controlled by medications, then surgery may well be performed safely, with adequate intraoperative monitoring. How does weight factor into the determination of the safety and efficacy of proposed surgery? As far as safety is concerned, if a patient exhibits good health, even with the need for some medication, reasonable excessive weight would not be a disqualifying condition. General anesthesia must be able to be administered with ease and maintained with safety. The surgery center at which I operate does have an absolute weight limitation of 300 pounds. Excessive weight, probably greater than 30% above ideal weight, may result in delayed recovery in that it may limit the ability to deep breathe and move about after surgery. This could lead to respiratory infection and other complications such as phlebitis, with its attendant complications. Thus, if there is such weight excess, diligent attention to postoperative mobility and deep breathing is essential. That weight excess again need not be disqualifying. What may also be affected by excess weight is the outcome of the surgical procedure from a functional and cosmetic standpoint, including the likelihood of the need for later revision surgery. For instance, in top surgery where the excess skin, breast, and fatty tissue are removed as part of the reconstruction in FTM top surgery, there will inevitably be residual fat and skin at the medial and lateral margins of the excision; that is, near the sternum and under the axilla (armpit). Some of this may be managed with liposuction at the time of surgery, but there may still be excess at the margins of the suctioned area. After a waiting period of six months to one year, this area may be improved with a surgical revision. Metaidoioplasty, under the best of conditions of clitoral response to hormonal therapy, is only able to create a small "penis". If there is excess fat in the abdominal region or in the suprapubic area, this penis will be even less noticeable if not effectively obscured by surrounding tissues. There are excellent reasons to lose weight prior to surgery, both for health considerations, and for the purpose of achieving the best possible surgical result in terms of appearance. I do recognize that individuals often have goals regarding weight loss that they may never, realistically, be able to meet. This is not because they do not have good intentions but rather because of life styles that are difficult to alter, other more important considerations in their life, or discouragement from previous failed attempts. As long as their general health does not preclude general anesthesia and they recognize the surgical limitations imposed by their weight, these individuals need not necessarily be denied the benefits of surgery as they proceed through their transition or to meet their other identity goals. |