In Jain dharma, the paap is judged mainly by the intention, attachment, and violence involved.

A surgery to change the body is not automatically the same as a very grave paap. Its karmic weight depends on:

• Why it is being done
• How much harm it causes to living beings
• How much attachment, ego, or desire is behind it
• Whether it is for healing/need or only for appearance

In simple Jain understanding:

• If it is done for serious distress, health, or to reduce suffering, the karmic burden is generally less than doing it out of vanity or strong attachment.
• If it is done mainly for beauty, pride, or changing the body out of desire, then it can increase raag, moha, and attachment, which is spiritually harmful.
• Any surgery involves himsa at some level, so from a Jain view it should be approached with care, restraint, and awareness.

The most important point

Jain dharma focuses not only on the outer act, but on the inner state:

• Less attachment = less bondage
• More ego/desire = more bondage
• Compassion and necessity = spiritually lighter than indulgence

What a Jain should keep in mind

• Choose the minimum harm option.
• Avoid doing it out of fashion, comparison, or ego.
• Stay in equanimity and avoid hatred toward the body.
• If possible, do pratikraman / repentance for any harm caused.

So, in Jain terms, it is not necessarily a very severe paap if the distress is deep and the intention is not worldly vanity, but it is still an action involving some himsa and attachment, so it should be done with great mindfulness and restraint.