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When seeking non-emergency surgery, surgeons consider several factors to determine if the surgery is right for the patient and if the procedure is safe for them. Unfortunately, when patients are turned down for surgery, one of the most common reasons is a high BMI. Surgeons performing plastic surgery or gender-affirming surgery do not want to chance a patient with a high BMI but who is otherwise healthy. This is unfair, and while there may be other legitimate reasons not to perform the surgery, BMI is used as a blanket reason to turn down patients.

Dr. Javad Sajan of Allure Esthetic employs a more holistic view of the patient, which has allowed him to help many people with high BMIs get the necessary gender-affirming surgery they need. Allure Esthetic provides the best high BMI FTM top surgery.

Understanding BMI & FTM Top Surgery

Female-to-male top surgery is a gender-affirming procedure that allows transgender men to achieve a masculine chest through a reconstruction process. It requires precise, careful techniques that help patients eliminate unwanted breast tissue and gain the appearance of a masculine or flat chest. The surgical techniques used are the same as when surgeons perform a mastectomy but eliminate even more excess breast tissue.

Male-to-female breast augmentation is a gender-affirming surgery that creates breasts for transgender women using breast implants. The surgical techniques and mechanics are similar to that of a breast augmentation on a cisgender woman. Overall, the procedure is relatively low-risk and involves minimal surgical time. However, based on many factors, some patients may be at a higher risk of complications.

Having a higher body mass index (BMI) does increase surgical risks. The extent to which a higher BMI increases risks varies widely between patients who have unique health histories and lifestyles. Therefore, it is important to understand what the BMI is and is not.

What BMI Measures

The body mass index measures your body mass (weight) against your height. In general, certain standards constitute a “healthy” weight. The healthy range is roughly 18.5 to 24.9. The overweight range is 25 to 29.9, and anything 30 and above is considered obese. However, a BMI measurement accounts for total mass but not what makes up that mass. For example, a bodybuilder who has very little body fat and a large amount of muscle likely has a BMI that would fall in the unhealthy range.

Yet, almost no one would constitute such a person as unhealthy, and they almost certainly would not be turned away from treatment. Thus, this exemplifies the flaw in the BMI measurement. While BMI can be useful and can indicate increased risk, it is not an overall determiner of health.

A person can be healthy at almost any size as long as they are getting enough nutrients and exercise. People of varying sizes have always existed and have lived long, fulfilling lives. With that said, of course, medical conditions, lifestyle, and other factors do impact BMI and overall health, but they are not one and the same.

Why Do Surgeons Have BMI Limits?

When performing non-emergency or elective surgeries, surgeons may place a BMI restriction on what will or will not qualify for surgery. This is due to the possible increased risks of performing surgery on high BMI patients. While it is an overgeneralization, this does result in only relatively healthy people undergoing these surgeries. However, of course, people with a “healthy” BMI can have other medical problems that also make them high risk.

Dr. Javad Sajan takes a different approach when evaluating his MTF breast augmentation patients with a high BMI. He does consider BMI, but he also reviews the patient’s medical history, medications, lifestyle, and whether their goals for surgery are realistic. If a patient has a high BMI but they do not smoke and have no unmanaged major health conditions, they may be a good candidate. However, please note that the factors listed above are not exhaustive,, and others may disqualify a patient from surgery separately from or in combination with their BMI.

Considerations For FTM Top Surgery Patients With A High BMI

When performing gender-affirming top surgery on a patient with a high BMI, there are considerations to make for the aesthetics and safety outcomes.

Incision Shape

FTM top surgery has a few options for incision shape that one should consider before surgery. Dr. Sajan uses a few different incision techniques depending on the patient’s preference and needs. These incision options include:

  • U Shape: One of the first, more traditional methods that provides a reliable incision. It’s best for patients who don’t want to look too masculine or feminine.
  • Pec: A pec incision provides a sculpted, masculine look to the chest and works great for almost all body types.
  • Keyhole: The keyhole incision is smaller and less invasive than other incisions. However, it usually leads to a flat, less masculine chest and does not work on all body types.
  • Straight: Straight incisions provide a stark contrast and structure but may not be right for high BMI patients as it does not work with removing excess amounts of tissue.
  • Inverted: The inverted incision is popular as it does not cut off blood supply to the nipple and does not require the nipple to be removed.

Patients with a high BMI may require larger breast implants to create a chest that is proportionate to their body. However, the patient’s chest and shoulder width also play a role in determining the right size breast implant for a patient. Transgender women tend to require larger implants regardless, but their weight and BMI can affect the size, projection, and profile a patient decides to choose for their high BMI MTF breast augmentation.


As previously mentioned, safety is always a concern when evaluating a patient for surgery. A high BMI may place a patient at higher risk of postoperative complications, but this does not mean it is not safe. If other relevant factors are present, the risk associated with a high BMI may be relatively minor. If a patient has undergone general anesthesia or similar surgeries before (and while at the same or a similar size), this may show they can handle the procedure. A more practical safety concern is that the surgical equipment is adequate for treating a patient of a certain weight or BMI. Some tables and beds have weight limits, and exceeding them can put the patient and staff at undue risk of injury. Many facilities do offer different equipment or an alternate surgery center that has the right equipment for the patient. However, these accommodations may not always be available.


Lifestyle factors can impact whether or not a patient is a good candidate for surgery. Examples of lifestyle factors Dr. Sajan may consider include:

  • Does the patient smoke?
  • Does the patient get an adequate amount of exercise?
  • Is the patient under a lot of stress consistently?
  • Does the patient have children they will need to care for immediately after surgery?
  • Does the patient plan to have more children?
  • What is important to the patient when considering the disruption surgery may have on their everyday life?
  • Does the patient understand and is prepared to potentially experience minor complications?
  • What health problems does the patient have?

Frequently Asked Questions

What Is The BMI Limit For Gender Affirming Surgery?

Dr. Sajan does not have a specific BMI limit for FTM top surgery. He has performed the surgery on patients with higher BMIs and seen great results. Every individual patient is different, and Dr. Sajan aims to understand the full scope of a patient’s health,, including and beyond their weight or BMI.

Can You Have Surgery If Your BMI Is Over 40?

Maybe it is difficult to say without a physical exam and consultation. Dr. Sajan has occasionally completed gender-affirming top surgery on patients with BMIs over 40. However, this is not his typical patient, but he is always willing to evaluate and discuss options with patients.

Weight loss is never the recommendation Dr. Sajan wants to make, but unfortunately, in some cases, it is good advice. Dr. Sajan can help patients find a weight loss method that works for them and may make them eligible for FTM top surgery.

How Long Are You Under Anesthesia For An FTM Top Surgery?

Patients are usually under general anesthesia for about one to two hours, depending on the specifics of the surgery. Combining other gender-affirming surgeries will add surgical time.

What Is The Cost Of A High BMI FTM Top Surgery?

At Allure Esthetics, a high MBI FTM top surgery starts at $8,500. The price may vary depending on the surgical methods required and other procedures the patient may want to include.

The cost of a high BMI MTF breast augmentation varies depending on the type of breast implant chosen. Contrary to popular belief, size does not influence the price of breast implants. The starting cost for saline breast implants is $5,995. Silicone and gummy bear breast implants will incur additional costs.

Insurance will often cover the cost of FTM top surgery. Reach out to your insurance company to determine if gender-affirming procedures are covered by your plan. Our dedicated insurance coordinators can also help you throughout this process.

The Best High BMI Transgender Top Surgery

Allure Esthetic Plastic Surgery is one of the leading facilities for patients seeking gender-affirming surgery in the United States. With a medical and administrative staff trained in gender affirmation procedures, we treat all of our patients with the respect and compassion they deserve as a bare minimum.

Dr. Javad Sajan also has extensive experience with gender-affirming surgeries and continues to learn the latest advancements to best serve his patients. Allure Esthetic Plastic Surgery offers the best high BMI MTF breast augmentation.

To learn more and schedule a consultation, call us at 206-209-0988. Patients can also reach out online via chat, contact form, or Price Simulator.

Allure Esthetic Plastic Surgery

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