Thinking about Gallagher and other butchers who do objectively poorer jobs on breast reduction than most surgeons. I wonder if one explanation is that these are some true believers who got into the trans field because they think they are serving an ignored pool of patients who desperately need help, so much so that if they don't get surgery soon, they will kill themselves. If surgeons truly think this, they can justify taking shortcuts, operating on patients with higher BMIs, and handwaving bad outcomes because they have saved someone's life. They are taking on risk where no one else will. If the patient dares to ask for it to look better, these true-believing surgeons can't process the idea that someone would nitpick how their organs that were causing them to be suicidal look. And if the patient keeps pestering them afterward, the doctors just think they are being genuinely difficult instead of someone who knows they've had a rush job.
I'm sure plenty of them are motivated by money and genuine psychopathy as well, but I think there's a misalignment between the medical people who think they're helping and the trans activists themselves. The suicide stat is mostly used to force social changes, but the doctors are taking it literally and it is decreasing the standard of care.