healthmedicinet

Transgender people who are obese are denied gender-affirming surgeries because of their size, it has been revealed.

Surgeons in the US are refusing to perform “top” surgery – the removal of the breasts – on patients, fearing they are at greater risk of complications and because of slower healing times.

Patients also claim that doctors have refused surgery because they would not be happy with the results and because of prejudice against fat people.

But some surgeons are now calling for this barrier to be removed, pointing out that it could put vulnerable patients at risk for mental health problems and there is little evidence that these individuals are at greater risk for serious complications.

Patients affected by surgeon refusals include Vince Wescott, 32, of North Carolina, who was told to lose 100 pounds before being considered for top surgery.

About 60 percent of people who identify as transgender have, according to estimates by the United States National Health Institutes.

About 25 percent of them come forward for a “top” surgery, of which about 14 percent are refused – often because of their weight.

Top medical guidelines don’t suggest limiting “top” surgery based on a person’s body mass index (BMI), but many clinics have put the limits in place anyway.

Arguments for this include a perceived higher risk of infection in obese patients and slower healing times as the extra weight puts a strain on their body systems.

There are also suggestions that patients will not like the results because the excess fatty tissue in the breast area can affect the aesthetic results.

Surgeons can also face technical difficulties, including shaping the chest and accessing the breast tissue to be removed.

But other surgeons have argued against this stance, pointing out that obese patients are no more at risk for extended hospital stays or return to the hospital than their healthy-weight counterparts.

An investigation into the risks of ‘top’ operations in 2021 by Georgetown University, based in Washington DC, found that obese patients were not at greater risk for serious complications ? requiring a return to the hospital ? than their healthy peers.

But they were more likely to have minor complications, at a rate of 31.5 percent compared to 12 percent for normal-weight patients.

These include infections, hematoma (or the buildup of fluid), and aesthetic issues, such as loss of nipple grafts 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, said STAT News“You’ve provided a huge improvement to this patient’s dysphoria and mental well-being in exchange for perhaps a small portion of a nipple graft that will eventually heal.”

“If I put that to most surgeons and most patients, I think everyone would consider that an acceptable risk.”

Patients affected by surgeons’ refusal to perform the surgery include Mr. Wescott of North Carolina. He had saved up the money, got a letter from his therapist and sent the required photos for the surgery – but was initially refused because he is obese.

Patients who have refused ‘top’ surgery because of their size include Azrael Dean Martinez (pictured)

“The doctor looked at the pictures and your weight is very worrying,” he recalled a nurse saying. “He won’t be able to do this unless you lose about 100 pounds.”

“It was like being hit by a train,” Mr Wescott said, commenting on the moment. “It cost me everything, I really didn’t want to live at that moment.”

Another patient who faced the same issue was Azrael Dean Martinez, 40, who was also denied top surgery during their consultation and was instead pushed to lose weight.

They accused the medic of judging them by their height, saying they remembered the doctor saying, “I refuse to treat anyone your weight because you won’t be happy with the results.”

They added, “It felt like I was talking to a wall. I felt ashamed.’

But some surgeons are now coming forward to offer the best 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 lifted weight restrictions.

Finally, Mr Wescott was able to have a ‘top’ surgery after seeing an Instagram post from a clinic saying it would be willing to perform the surgery on larger individuals.

He did develop an infection after surgery, but blamed the 12-hour drive back from Florida to North Carolina where he accidentally opened a wound.

It’s because many Republican-led states are trying to crack down on “top” surgery being offered to minors.

They claim that the individuals are still too young to make an irreversible change in their bodies.

But others have hit back at the legislation, saying it’s only a very small minority who get top surgery this early.