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Excess Skin, Body Contouring Surgery

Franny M Patient Story

After losing an astonishing 225 pounds between 2013 and 2017 through diet and exercise (and with the support of a nutritionist and personal trainer), 26-year-old Franny McEneaney was proud of herself – but disappointed by all of the excess skin.

“I’m a nurse, and I’d watched enough episodes of My 600-lb Life on TLC to know that when you lose a lot of weight, you’re left with loose skin!” Franny says. “But after all of my hard work, I was still disappointed that I still couldn’t wear the clothes I wanted to wear.”

The skin hanging from her arms and stomach was Franny’s biggest insecurity. She started thinking about skin removal surgery, wondering what options existed. But one thing she already knew for sure: If she underwent skin removal, she wanted to be treated at a hospital system as opposed to a surgery center.

“As a trauma surgery ICU nurse, I’d seen patients come in with serious complications and infections stemming from procedures. I needed to be sure that if anything happened to me, my doctors would have the resources that a top hospital provides. I was also focused on finding a specialist who truly cared.”

Specialists like the ones she’d met at Penn Medicine a few years earlier.

Franny’s First Time at Penn Medicine

In 2012, when she was 22 (and not long before the start of her weight loss journey), Franny developed hydrocephalus, the buildup of fluid in her brain cavities. A shunt had to be inserted to drain the accumulation.

“From the front desk staff to my doctors, everyone at Penn Medicine was wonderful. I felt like they really cared about my entire wellbeing as I went through the surgery and recovery, and all of the prep. All these years later, my neurosurgeon, Dr. Sean Grady, still calls me once a year to follow up and see how I’m doing. I promised myself that I wouldn’t undergo plastic surgery unless I could find that same level of expertise and care.”

She took the most obvious first step.

“I Googled ‘Penn Medicine plastic surgery.’”

Body Contouring Backed by Expertise

Franny didn’t know whether Penn Medicine even offered post-weight loss plastic surgery, but her search brought her to Penn Plastic Surgery’s webpage. It described Body Contouring After Weight Loss, a program offering plastic surgery (sometimes called a “body lift”) for people who have lost a substantial amount of weight either through diet and exercise alone or through bariatric (weight-loss) surgery. Candidates for Body Contouring After Weight Loss have excess skin they want or need removed for confidence or comfort-related reasons. Body Contouring After Weight Loss also offers the support and resources patients need to sustain their newly healthy lifestyles.

Franny filled out the form on the webpage. A scheduler called her two days later.

“She told me that the first available appointment was with Dr. Fischer. I took the appointment, but I’m research-driven, so I needed to learn more about him to decide whether to cancel it or keep it.”

Franny dove headfirst into researching John Fischer, MD, MPH, FACS, and Director of Clinical Research Program, Division of Plastic Surgery at Penn Medicine.

She liked what she found.

“I discovered that he’d conducted a lot of renowned research on the abdomen – not just related to body contouring after weight loss, but abdominal surgery in general. I also found journal articles citing scenarios where he’d fixed other surgeons’ mistakes.”

But there was still the matter of clicking in person – another one of Franny’s requisites. That, too, took care of itself.

“When I showed up for the appointment and met Dr. Fischer and his physician assistant, Sherri, I felt completely at ease. Instantly.”

Dr. Fischer, Sherri and Franny talked for half an hour about Franny’s weight loss journey and her goals. Dr. Fischer walked her through the ins and outs of abdominoplasty, surgery to remove excess weight on the stomach, and brachioplasty, an arm lift.

“He asked about my tolerance for scarring,” Franny remembers. “The abdominoplasty that he thought would be best for me would create a big T-shaped scar from my hips to my chest, and the brachioplasty he had in mind would leave a scar the length of the incision from my elbow to my armpit.”

Franny explained that she was okay with scars – that she was more concerned about fitting into and feeling good in clothes. “But I appreciate how he encouraged me to really think about it. He asked if he could draw lines on my arms and stomach. It helped me visualize what life would be like with those scars on my skin.”

Franny wasn’t deterred. The opposite, actually.

“I decided to move forward with the abdominoplasty and brachioplasty.” Before leaving the building, she talked to a coordinator and scheduled her surgery.

Preparing for the Combined Procedure

In the weeks following, Franny underwent the standard pre-surgical preparation: A physical and a few more conversations with Dr. Fischer and the Penn Medicine care team.

“They review the potential risks and make sure you understand what you’re having done and what recovery entails. They double-checked my comfort with the scarring.”

At home, Franny prepared by buying a big, comfortable recliner and placing it in her family’s living room.

“Because of the brachioplasty, I would have to keep my limbs elevated so they wouldn’t swell, and because of the abdominoplasty, I couldn’t lay flat for a few weeks. Plus, it would be awhile before I could climb stairs up to my bedroom.”

The abdominoplasty and brachioplasty were performed simultaneously at Penn Presbyterian Medical Center as an outpatient procedure. Dr. Fischer inserted several drains in Franny’s stomach and arms, and she went home that same day.

“Honestly, the recovery was a little tougher than I expected,” she admits.

There’s discomfort for several weeks, and Franny found herself feeling paranoid at times as she recovered in her recliner, wondering if an incision in her armpit looked strange or might be infected.

“I remember snapping a picture of my incision and sending it to Dr. Fischer through the Penn Medicine portal at 11pm. I went to sleep, and when I woke up in the morning, I saw that he’d responded at 2am.”

Dr. Fischer explained that the incision point was taking longer to heal because it was in the crease of her armpit, but that there was no reason for concern.

“It just meant a lot, getting an answer from him that quickly.”

Franny’s recovery and follow-up appointments at Penn Medicine went smoothly. Her drains were removed, and after five weeks she returned to work in the ICU with far less skin on her arms and stomach.

“Right away, I felt more confident. Happier, even. And shopping for clothes became so much easier.”

The Final Leg of the Weight Loss Journey

Since her first procedure in 2017, Franny has maintained a stable weight and undergone three more procedures with Dr. Fischer, starting with a breast lift and augmentation.

“I’d explained to Dr. Fischer that I didn’t want an augmentation, per se – I really just wanted my breasts to look less deflated, the way they looked before I lost weight. I was really worried about them looking fake after the procedure, but I left the details up to him.”

Dr. Fischer chose Franny’s implant size and removed excess skin.

“The results are amazing,” she says. “I was relieved. He was so attuned to what I was looking for.”

A year later, she had a thighplasty to remove excess skin on her upper legs.

“Dr. Fischer made an incision from my knee to my groin. The results are great, and the recovery was similar to my first surgery. It was nice knowing what to expect this time.”

Although the thighplasty was successful, Franny had so much excess skin on her thighs that she needed what’s called a thigh revision – another procedure to finish the job, which she underwent just a few weeks ago. Dr. Fischer followed the incision lines from Franny’s previous surgery to prevent any added scarring.

“Dr. Fischer told me from the start that my thighs might be a two-step process, because it wouldn’t have been safe to keep me under anesthesia for as long as he’d need to remove all of the skin. I remember him asking if that was okay, and I said, ‘I want to be safe – so of course.’”

Much Lost, More Gained

Franny is fairly sure that her body contouring journey is complete – and she couldn’t be happier. She continues to maintain her weight through a healthy diet and exercise, and can finally wear the clothes that she’d been dreaming of. Most importantly, she feels free of the weight-related challenges that plagued her for so many years.

“I finally recognize the person in the mirror,” she says, “My body finally matches my perception of myself. It’s made everything feel complete, and I couldn’t be more grateful to Dr. Fischer and his team at Penn Medicine.” 

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