will take care of you regardless of your weight... but I personally would want you to acknowledge that your weight is stable and not still fluctuating. There are more wound complications with greater BMI's and obesity so you have to accept this too as well as the possibility that if you are successful in the future with weight loss, that you may shrink to where you may desire an implant at more costs and surgery.
Every patient is different as are their circumstances. As doctors we need to evaluate each patient individually so yes, we can and do sometimes make exceptions to the "rules." With that said, it is better to lose the weight first if at all possible. It may not be possible for you. You should seek a consultation with a board certified plastic surgeon in your area to discuss your individual circumstances. Good luck to you.
Congratulations on your stopping smokiing. That helps a lot. If you are having trouble losing weight it might be good to consult with a bariatric surgeon. Your BMI is drastically high and your weight is a serious threat to your health and your lifespan. We are doctors first and surgeons second and no one interested in your health would consider putting you at risk for a purely elective surgery that could be performed after weight loss.
We frequently make exceptions for people who are overweight depending on their individual circumstances. There are many factors that are evaluated including but not limited to the size of the breast and any medical conditions which may preclude surgery. Insurance companies frequently deny coverage for the procedure in overweight patients recommending conservative measures and weight reduction in lieu of surgery making this a catch 22 for you. You might wish to seek the opinion of a local plastic surgeon to see if their are any reasonable options for you. Good luck. Dr Friedlander