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Penile enlargement
Phalloplasty
It is estimated that 250,000 men worldwide have undergone phalloplasty, half of those have been in the US. Traditional penile-enhancement surgery involves one or both of two basic procedures. The first, to increase length, involves making an incision at the base of the penis and snipping the ligament that anchors it to the pubic bone. This causes the portion of the penis that is normally inside the body to fall forward, giving the illusion of more length -- usually about an inch, but up to two and a half inches.
The second procedure, penis widening, adds girth to the penis. This requires the insertion of a filler material under the skin of the penis and can increase girth by up to 30 percent.
What does it cost?
The costs vary but generally penile lengthening ranges from $4000 - $6,000 and penile widening, from $7,000 - $8,000. Penile widening is generally more expensive because of the filler materials used.
What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility. The procedures each take about 1˝ - 2 hours but depending on the extent of the procedure, it could take longer. It is not advisable that both the procedures are undertaken at the same time. An overnight hospital stay is not usually required but you will spend several hours under observation.
Lengthening procedures are performed under general anesthesia. Incisions are made at the root of the penis where it joins the pubic area. The penis is then released from its attachments (suspensory ligaments) to the pubic symphysis. The space is closed with local tissue. Skin from the penis and/or the pubic area is used to cover the new extended penis. Post-operative traction using weights reduces the chance of retraction and provide more natural shaft skin.
Penis widening can be done in several ways through a free fat transfer or grafting. The most common substances used for grafts are ALLODERM® and dermis-fat.
Free-fat Transfer is performed under local anesthesia with a mild sedative With this technique, your own fat is gathered using liposuction and then transferred into your penis.
The Dermis-fat Graft procedure involves harvesting a wedge of skin with fat attached to from another part of the body, typically the lower abdomen just above the pubic hairline. Many men have a bit of redundancy in this region and the surgery gives them the added benefit of a mini tummy-tuck. Other men prefer the crease under their buttocks. This location can be a problem if the scar is thick and uncomfortable, as the patient will be sitting on the area. After harvesting two grafts, the grafts are inserted lengthwise through a tunnel made on each side of the shaft. Otherwise, the surgeon will make a Z-shaped cut along the penis and then cut out a narrow 2 inch strip of fat with its overlying skin from the groin and move it while it is still attached to its blood supply to the lengthwise cut in the penis and suture it in place. The tissue continues to nourish the fat after it has been transplanted and brings the body's own blood supply to ensure the graft's survival.
An ALLODERM® Graft is made of human collagen tissue (reissued cadaver tissue), which has been purified to minimize the risk of spreading disease and rendered non-immunogenic. It does not require a skin test prior to the procedure. In this technique, the graft is put into your penis much like a dermal graft, however, this procedure is reversible.
The newest phalloplasty procedure is called the MISL© procedure (Minimally Invasive Surgery with Laser). With this procedure, no actual length is created but the internal portion of the penis is "advanced" or "externalized," exposing greater length. This is accomplished by resecting (cutting) a portion of the suspensory ligaments which hold the penis against the undersurfaces of the pubic bone between your legs. Because this procedure is done with lasers, it leaves a smaller scar than traditional lengthening surgery.
Are there risks or potential side effects?
As with any surgery, there are risks, including an allergic reaction to the anaesthetic. Specifically, penis enlargement carries the following risks and side effects:
- swelling, bruising and mild discomfort usually occur
- infection
- sensation may be altered or completely lost
- function may be altered
- erections may become more horizontal than vertical
- delayed wound healing and/or poor scarring may occur
- bleeding may occur and should blood collect (a hematoma), this may require further surgical treatment
Smoking can increase the risks of this procedure because nicotine constricts the blood vessels, decreases blood flow to tissues and greatly increases the chance of scarring. Patients who smoke can actually lose a portion of skin decreased oxygen flow into the skin caused by nicotine and decreased skin oxygen levels caused by carbon monoxide can cause the skin to die. These risks are significantly reduced if you stop smoking at least two weeks before surgery and wait until you are completely healed before starting again.
With respect to the results of these procedures, there are no guarantees with respect to the final size and lengthening without a widening procedure may make the penis look thin. Penis shape cannot be assured with a widening process. The healing process takes time and the final result will not be readily visible for many months but sometimes, revisions may be necessary.
What to expect post-procedure?
You will wear a light pressure dressing for at least a few days and elevation is recommended as well as wearing jockey shorts. The penis and scrotum are usually swollen and bruised for two to three weeks. You will be sore in the groin and pubic regions for up to two weeks, but this can be controlled with medication. You will see the doctor two to three days after surgery. At this time, it is possible that you are able to shower or bathe and start your own wound care and shaft wrapping. Sutures are removed 7-10 days post-op.
Many doctors will also recommend manual stretching at one week and a weight program, where post surgery, weights or another traction method are hung from your penis to sustain and increase the length. Weights are used at two weeks for a lengthening procedure only, or three weeks for fat autografts, and four to five weeks for derma fat grafts or flaps. Some patients maintain traction for up to 6 months after surgery, which will reduces the chance of retraction, stretch the shaft skin and in some cases results in further lengthening by stretching tissues which could not be cut at surgery. Scars may take many months to fade and soften.
How soon does normal life resume?
It is highly recommended that you take two weeks off minimum, and then slowly reintegrate yourself back to normal life. Avoid sexual intercourse and heavy sports and activities for at least 4-8 weeks.
Even after free-fat transfer, it is best to give the new cells at least 3-4 weeks to heal and early sexual activity might cause them to shift to an unwanted location.
Who performs it?
This procedure is normally performed by a plastic surgeon or a urologist.
Are you a good candidate?
As with any cosmetic surgery, it is important to have realistic expectations the outcome of the surgery – this is a prerequisite. If you feel that penile enlargement may be appropriate for you, make sure:
- Your surgeon is aware of any and all medical conditions and any allergies you may have and. Also, tell your surgeon about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- You are not prone to scarring problems such as keloids.
- You do not smoke.
- You have a good understanding of the limitations of the procedure.
Smokers are advised to stop for two weeks prior and at least two months post surgery. Complete cessation is recommended as new research indicates that smokers heal very slowly.
How to prepare for surgery?
Many doctors will not perform the surgery without an evaluation by a either a psychiatrist or psychologist. Also, because smokers heal poorly, many doctors will not perform the surgery unless the patient quits smoking at least two months before the surgery. Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Avoid drinking alcohol a few days before your surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anaesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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