Miscellaneous Topics - Penis enlargement

What is penile augmentation and what techniques are available to achieve it?

Penile augmentation is divided into two categories:

1. Penile Lengthening
2. Penile Girth Enhancements (widening or thickening)

Penis Lengthening: There are two main types of procedures for elongation, or the adding the appearance of penis length.

1.     Liposuction: Reduces fat around the base of the penis in order to expose more of the base area of the penis, therefore giving an appearance of greater length. This technique is performed primarily in obese men when their protruding belly conceals some of the base of their penis. The amount of fat that can be extracted in liposuction varies in each man. In some men, fatty tissue may have to be cut out.

2.   Ligament Release: Cuts the suspensory ligaments to expose the portion of the base of the penis that is found behind the pubic bone. A ligament is a band of tissue that holds the penis closer up against the pubic bone. Detaching the penis from these ligaments releases this portion of the penis from the base, freeing more of the penis to hang from the pelvis, giving it the appearance of greater length. However, some men find that they do not gain any length during erection after having this surgery. After surgery, patients need to attach external weights to their penis in order to prevent re-attachment of the ligament to the pubic bone so that their additional penile length gain is reversed. Sometimes, fat from other areas of the man’s body is placed in the area of ligament release to also prevent re-adherence. Other techniques with tissue expanders are sometimes used.

Penile Girth Enhancements: There are also several options for widening or thickening the penis.

1. Grafts: A graft is when a healthy tissue is removed from one site on a person’s body and transplanted to another.Penile girth can be increased by placing different types of tissue (like fat or tissue grafts) under the skin of the penis.

2. Fat Injection: Injects biosynthetic fat or fat from another area of the man’s  body area into the penis. Unfortunately, this fat is often reabsorbed within a year or two, or in some cases in a few months. When this happens, the penis returns to its original size. Also, as the fat settles, lumpy deposits sometimes form that can look and feel strange. Therefore, results are only temporary, often leading to the procedure having to be done over again to maintain the results. As a result, doctors often have multiple sessions where they inject less fat each time. This increases the chance for the fat injected to obtain a new blood supply and survive, which also reduces reabsorption and lumps from appearing.

3. Flaps: Involves taking tissue flaps from the surrounding pubic area and repositioning them into incisions made at the base of penis. The end of these flaps that are still attached to the patient are then tunneled under the skin on the shaft of the penis and the other end of the flap is anchored at the far end of the penis (near the head of the penis). The major benefit to this procedure is that since blood supply to the tissue is preserved, survival of the tissue is often good. Unfortunately, because of its complexity, this procedure takes longer than the others. Also, bulging at the turnover area at base of penis sometimes occurs, but this usually reduces over time.

Often combinations of the above treatments are done. The surgical method that the doctor decides to perform on a patient often depends on the man’s body type.

Additionally, it is very important for patients to have realistic expectations since surgeons cannot "create" length. They merely work with a man’s natural endowment.  Therefore there is no way to guarantee a specific gain in length.

What type of doctor should perform this surgery?

A good place to start is to consult a primary care physician. He/she can then refer a urologist, or counselor/psychologists/psychiatrist, that can further discuss any concerns, as well as the possible treatment options that are best for each patient.  A urologist specializing in Phalloplastic Surgery should do penile augmentation surgery.