Types of Penis Enlargement Surgery

Surgical techniques to lengthen a penis (enhancement phalloplasty) or increase its circumference (girth enhancement) are nothing new. They were first introduced in the United States in 1991. Unfortunately, there arent enough studies of penis enlargement surgery to provide an accurate picture of results and risks. However, one study at the Institute of Urology in London concluded that only 35% of the patients who underwent surgery were satisfied with the results, and half went on to seek further surgery.

Generally, procedures meant to thicken the penis are more effective than those intended to increase penile length. The currently advertised techniques used for penis enlargement include:

  • Detaching the suspensory ligaments that connect the penis to the undersurface of the pubic bone to lengthen it. This procedure, which can be done as an outpatient surgery under general anesthesia, sometimes uses a laser to cut the ligaments. It is based on the fact that only approximately two-thirds of the penis extends beyond the body. By cutting the ligaments that support the other third inside the body, the internal portion of the penis advances. Some practitioners claim a gain of up to 2 inches in the flaccid state, but a study published in European Urology in 2006 reported that the average length gain from penile enhancement surgery is less than an inch. This surgery also only changes the length of the flaccid penis; its size while erect is unchanged. Cutting the ligament incorrectly can cause an erect penis to be unstable or position itself at odd angles. Once severed, the ligament does not provide stability to the penis as it once did. The postsurgical regimen includes daily stretching of the penis with weights to prevent the severed ligaments from healing shorter than they were previously. The penile stretching device, which is used for 6 months or longer, is considered essential to the success of this procedure. The American Urological Association (AUA) considers the cutting of the suspensory ligament of the penis for increasing penile length in adults to be a procedure that has not been shown to be safe or effective.
  • Taking skin flaps from the pubic region and adding them to the penis to increase its circumference. This can result in severe deformities (including hair growth on the underside of the penis), scarring, and other problems.
  • Harvesting fat from other body areas and injecting it into the penile shaft to widen it. This technique is known as free fat transfer (FTT). The resulting penis is the same shape and length but has a greater circumference. Some doctors claim an increase of 50% or more in circumference, with best results realized after a second procedure that takes place 3 months after the first. Increases reportedly occur in both the flaccid and erect states, with a greater gain in the flaccid state. The drawback with fat grafting is that the body often absorbs most of the new fat within a short time. The AUA considers injection of fat cells for increasing penile girth to be a procedure which has not been shown to be safe or effective.
  • Another alternative is tissue grafts from cadavers, known by the brand name AlloDerm. The material is rolled in several layers around the penile shaft for thickening. This is an off-label use of the product, which has been approved by the U.S. Food and Drug Administration for use in the United States, but not for penis enhancement. In fact, the FDA has specifically not approved AlloDerm as a void filler or for cosmetic augmentation. AlloDerms manufacturer, LifeCell, does not recommend or promote this application either.

When done for cosmetic reasons, penile enlargement surgery is not covered by medical insurance, which means the patient must pay all fees himself.

Penile Implants

Another category of penis enhancement surgery uses inflatable penile implants. Introduced in the 1970s, this primarily therapeutic surgery is performed on men suffering from erectile dysfunction (ED), which is the inability of a man to attain and/or maintain an erection sufficient for sexual activity. Implants may be the last hope for men who cannot take ED medications or for whom those medications do not work. Implants are also used in men with Peyronies disease, a disorder that causes internal scarring that can lead to bent or painful erections.

Penile implants, or prostheses, are devices that are implanted completely within the body. They produce an erection-like state that enables the man to have normal sexual intercourse. Implants come in two basic designs. The inflatable (hydraulic) implants are filled with saline from a reservoir implanted in the groin or scrotum and then deflated. Semirigid, or rod, implants are always somewhat firm.

Penile implant surgery is complex and permanent. It is usually done at a surgery center or hospital by a urologist. The surgery generally takes between 1 and 2 hours under general or spinal anesthetic administered by an anesthesiologist. It is costly, but if done for therapeutic reasons it may be covered by medical insurance, including Medicare. Neither the operation nor the implants interfere with sensation, orgasm, ejaculation or urination. A penile implant erection will be shorter than the erection the patient once had normally.

Through an incision above the penis where it joins the abdomen or under the penis where it joins the scrotum, the surgeon stretches the two tissue-filled erection chambers (corpora cavernosa) that normally engorge with blood during an erection and implants the cylindrical prostheses. No tissue is removed and blood loss is minimal. If inflatable implants are used, the surgeon also places a pump inside the scrotum. Depending on the design of the inflatable implants, a fluid-filled reservoir is either part of the pump mechanism or it is implanted separately in the lower abdomen. Semirigid implants, which are used less often, do not require a pump or a reservoir.

The decision about which type of implant to have is based on the patients preference and medical situation. It should be made in consultation with the surgeon performing the procedure.

Surgery Considerations and Alternatives

Candidates for penile implant surgery are first evaluated by their surgeon to determine the cause of their erectile dysfunction and to determine if they are a good candidate for surgery. They should be in good general physical and mental health and have any chronic conditions (diabetes, asthma, cardiovascular disease) under control. They should also have realistic expectations about what the surgery can and cannot do for them. The surgeon should also make sure that the patient has an understanding of the procedure, its risks and complications. Including the patients partner in the consultation is a good idea.

Penile implant surgery is usually the last option for men suffering from erectile dysfunction. For men who are considering cosmetic penile enlargement, however, there are usually other options. A mans first step should be to consult with his personal physician about his concerns. The doctor may be able to allay many of them. Sometimes something as simple as trimming the pubic hair, losing weight, or better physical conditioning can make the penis appear longer. Another option is pubic liposuction, which involves removing excess fat from the pubic mound that conceals the penis in obese men. By removing the fat, the penis appears larger, although its actual size does not change. And, if a mans concerns center on being inadequate as a lover, open communication with his partner can go a long way towards dispelling that belief.

Changing the size of the penis is expensive, risky, sometimes unstudied, and most likely irreversible. Ask yourself, Are the supposed benefits worth the risks?

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