BMI and being a low risk surgical candidate for transgender vaginoplasty

Talking about BMI and the ideal surgical vaginoplasty candidate.  Patients undergoing anesthesia for 4 to 5 hours (operating time is less),  need to have enough protein on board to ensure good wound healing and of course at the other extreme be not too heavy as fat against fat does not heal well.  A heavy torso weight can result in wound separation when you sit on your incision.  True this can be optimized by using a ring pillow for 4 to 5 weeks, but still experience with numerous patients confirms my judgment which has remained unaltered for the past 5 to 10 years.

BMI, an abbreviation for body mass index is a ratio of weight to height.  True normal is 18.5 to 24.9 but I tend to think of normal as 20 to 25.0  Being 25 to 30 places one in the euphemistic category called “overweight”, but 30 and above relegates the patient to being “obese.”  Fighting words, because some muscular patients will argue that have very little fat on board.  When this argument is proposed, we ask for a waistline circumference which should  never be over 40 inches, as a pinched abdominal skin thickness in inches versus the skin on the back of your hand confirms that your F-A-T scores are high.  Look at pictures men and women in physical fitness magazines and you’ll see thin waistlines.

Remember 80% of our patient receive a scrotal graft extension.  In a fatty pelvic space the vascularity is reduced meaning your graft may not take.  Also heavy legs are more likely to incur peripheral nerve injury being in stirrups for over 4 hours.

Here are standard BMI’s taken from   National Heart Lung and Blood Institute Logo

Weight Status
Below 18.5          Underweight
18.5 to 24.9         Normal or Healthy Weight
25.0 to 29.9         Overweight
30.0 and above   Obese

Harold M. Reed, M.D.
The Reed Centre for Transgender Surgery – Miami


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