Reply To: Optimal BMI for mesh removal..?
True and astute observation: if you have more fat under the area of the mesh placement, then removing it is somewhat easier over sensitive areas, such as nerves and vessels.
That said, we don’t typically place mesh with the primary intention of removing it. :p
Very very thin people have virtually no fat in these spaces. They have been shown to have more postoperative chronic pain, possibly due to the lack of fat to buffer some of the inflammation and stiffness from the foreign body. I usually tailor options for patients, including taking their BMI into account, when recommending options for them surgically.
Most people naturally have fat in these places, even if they are considered thin by U.S. standards. That amount of fat is adequate. Also, you cannot gain fat in the retroperitoneum. You either have it or your don’t and gaining weight will not preferentially increase the size of the fat cells in the region. If anything, gaining weight may jeopardize the outcome after mesh removal, by increasing surgical site infection risk and hernia recurrence risk.
Short answer: no, we do not recommend gaining fat prior to mesh removal.