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 happens during the procedure?

The surgical procedure may be carried out in an outpatient surgical facility. The procedure is either performed by the surgeon or by the hospital facility. It takes about one or two hours for the complete procedure to be performed; it may take even longer according to the extent of the procedure. An overnight stay at the hospital is not necessary but the patient is kept under observation for several hours.

General Anaesthesia is given to the patient during lengthening procedures. The procedure involves making an incision at the place where penis joins the pubic area. Next step is to release the penis from suspensory ligaments attaching it to the pubic symphysis. Local tissue is used to close the space. The new part of the extended penis is covered using the skin from the pubic area and or the skin from the penis. Use of post-operative traction is advised to minimise the chances of retraction and create more of natural shaft skin.

Penis widening can be done in several ways through a free fat transfer or grafting.

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

Nicotine intake associated with smoking causes constriction of blood vessels. As a result of this constriction lesser blood flow to the damaged tissue occurs and chances of scarring increase. Smokers undergoing this surgery may actually lose a skin portion due to decreased oxygen flow within the skin because of nicotine. In turn, the decreased skin oxygen levels due to carbon monoxide may result in dead skin. However, these risks may be greatly reduced if the patient quit smoking before ( at least two weeks ahead) the surgery and does not resume the habit until healing process is complete.

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.

Sometimes doctors may also suggest a routine of manual stretching for a week combined with a weight program. The post-surgery weight program includes hanging of weights and other traction methods from the penis to increase the length and maintain it. Lengthening procedure includes weight program to be followed for two weeks, three weeks in case of fat autografts, and four to five weeks for the procedures involving derma fat grafts or flaps. Some patients are able to maintain traction for up to six months post the surgical procedure. This helps in reducing the chances of retraction and stretching of the shaft skin. Maintain traction for longer period may also help in achieving further elongation due to stretching of the tissues that were not cut during the surgery. Scars after the surgery fade away and soften over a long period running into months.

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.
  • Intake of alcohol should be avoided for a few days prior to the surgery.
  • Ask for help from someone who would drive you home after the surgery and assist you for at least 24 hours.
  • Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.