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.
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
- 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.
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.
This procedure is normally performed by a plastic surgeon or a urologist.