Surgical Methods of Enlargement
Penile Augmentation Surgery, medically known as Phalloplasty, has certainly grown in popularity over the last decade. In fact, according to one well known specialist in male genital surgery, Dr E. Douglas Whitehead, since the early 1990's, around 40,000 men world-wide have undergone such procedures. In America alone, around 5,000 men a year now opt for penis enlargement surgery purely on cosmetic grounds.
The increasing popularity of cosmetic penis enlargement surgery is actually quite surprising. Although surgery remains the only method of penis enlargement recognized by the medical profession, it is extremely controversial. Many plastic surgeons either refuse to carry out the procedures or have now stopped performing the techniques because of the risks involved and the complications that can arise. In fact, several eminent organizations such as the American Urological Association and the American Society for Aesthetic Plastic Surgery still consider the techniques used in penis enlargement surgery to be of high risk and state that the safety and effectiveness of the procedures have not yet been fully established.
Several different techniques are used in penis enlargement surgery and penis lengthening and thickening are achieved through separate procedures. These procedures can be either performed individually or at the same time.
Surgical Lengthening Procedure:
Surgical lengthening of the penis involves cutting the suspensory ligaments that support and connect the penis to the pubic bone. These suspensory ligaments also secure approximately half the length of the penile shaft within the body. When the ligaments are severed, this hidden part of the penis extends forwards and outwards, encouraging a larger portion of the penis to be exposed. The penis is therefore, not actually lengthened but merely pulled further out of the body.
The effectiveness of the procedure varies between patients and it is impossible to determine likely results before the surgery is performed. In the majority of cases, gains in flaccid penis length are far more prominent than increases in erect length. Most men achieve an increase of around one inch in flaccid length following surgery, although gains of up to two inches are possible. According to one study involving fifty-eight men who underwent the lengthening procedure, the average gain in erect penis length was less than half an inch.
Unfortunately, approximately five percent of men do not experience any increase in either flaccid or erect penis length following surgery. In a minority of cases, penis length is actually reduced due to the formation of scar tissue that toughens and shrinks after the operation. In fact, in order to prevent this type of tissue shrinkage an essential part of the postoperative treatment involves continual stretching of the penis. Without this stretching, initial gains are often lost.
Cutting the suspensory ligaments can have further drawbacks. One of the most noticeable side effects of the procedure is that the angle of erection is usually significantly reduced. Without the suspensory ligaments to support the penis, erections often point straight out or even downwards. This doesn't affect sexual performance but may look less aesthetically appealing. A more serious effect however, is that the penis is no longer firmly held in place and is therefore more susceptible to injury.
Penile Girth Augmentation:
Although the above procedure is the only way to surgically lengthen the penis, there are several different techniques used to increase penis girth; all of which have both advantages and disadvantages. Generally, these techniques are more successful than the lengthening procedure and often provide an increase in penis girth of around thirty percent. In reality, this means that most men gain about an inch in flaccid girth and around half an inch to an inch in erect girth.
One of the techniques used to increase penis girth is known as Fat Transfer. This procedure has been in use since the early 1990's and involves collecting fat cells from the abdomen or inner thighs through liposuction, purifying the cells and then injecting them along the length of the penile shaft. The cells are injected just under the surface between the erectile tissue and the skin.
One of the main advantages of the Fat Transfer method is that no incisions are made to the penis, the fat cells are injected. As such, the penis suffers less trauma and so recovery is usually quicker than with other methods of girth enhancement. However, there are certain drawbacks. One of the main problems is that long term results can be unpredictable. A proportion of the fat cells are always reabsorbed back into the body and the increase in girth is partially lost over a period of time. It also possible that the fat cells will not be reabsorbed evenly or will group together to form fibro-fatty nodules. In these instances the penis may develop asymmetry or a lumpy uneven appearance. It is not uncommon for men to need further treatments to rectify these problems. Another common complaint is that when the penis is erect, the fat cells often feel softer than the erectile tissue underneath.
Although the use of the Fat Transfer procedure is still common, a more sophisticated procedure known as Dermal Fat Graft Augmentation is also available. The technique is more complex and involves removing two strips of tissue consisting of all the layers of skin and attached subcutaneous fat from the folds between the thighs and buttocks and then inserting these strips under the skin of the penile shaft.
The results of this procedure are considered to be superior to those achieved through Fat Transfer and are generally far more stable over time. The transferred tissue suffers less trauma than purified fat gathered through liposuction and a greater proportion of the tissue survives. Also, it would seem that because the grafts are more securely placed, they are not as easily reabsorbed by the body and as such much of the added girth is permanent.
An important disadvantage of the procedure is that quite sizeable grafts must first be taken from the patient. The procedure usually requires two dermal fat grafts, each approximately six inches long and two inches wide. Therefore, the incisions made in the gluteal folds are substantial, recovery can be painful and large visible scars may remain. It is also possible although uncommon, for the grafts to contract in size over time or for segments of the grafts to not survive. In these circumstances penile curvature or asymmetry may develop. A final point worth mentioning is that the surgical procedure takes several hours to complete and therefore, the risks associated with being under a general anaesthetic are increased.
Very recently, a variation of Dermal Fat Graft Augmentation has been developed. Instead of using dermal grafts taken from the patient, this procedure uses a substance known as Alloderm. Alloderm, developed by LifeCell Corporation, is made from thin sheets of freeze dried cadaver skin i.e. skin taken from dead humans. This skin is treated to remove the risk of rejection by the recipient and to ensure it is free of diseases such as AIDS and Hepatitis. Alloderm graft strips are layered around the penis in a similar manner to Dermal Fat Grafts. Several layers of Alloderm can be stacked on top of one another to provide the desired increase in girth.
The use of Alloderm grafts has several advantages. An important benefit is that the graft tissue is not taken from the patient and no incisions need to be made elsewhere on the body. Therefore, recovery from surgery is less painful and the often visible scars to the buttocks associated with Dermal Fat Graft Augmentation are avoided. Also, the entire procedure takes far less time to complete. Whereas Dermal Fat Graft Augmentation takes at least three hours to perform, the use of Alloderm reduces this time to around one hour. The risks associated with anaesthetics are reduced and because the procedure is less invasive, it is even possible to carry out the entire operation under a local anaesthetic.
At present there seems to be conflicting opinions as to the long term stability of Alloderm. Certain specialists suggest that Alloderm has a high absorption rate and do not use the material. However, others such as Dr E. Douglas Whitehead have abandoned the use of Dermal Fat grafts altogether and now exclusively use Alloderm. It is also suggested that there may be an increased chance of rejection by the patient because Alloderm is foreign tissue. However, Alloderm has been used successfully for a number of years in the treatment or burns and other traumas requiring tissue grafts. It is therefore likely that rejection of the material is only a remote possibility.
The use of Alloderm does seem to eliminate many of the drawbacks associated with Dermal Fat Graft Augmentation. However, as with any procedure complications can occur. Although remote, the possibility of rejection or absorption of the tissue does remain. Furthermore, as with the use of Dermal Fat grafts, there is a possibility that Alloderm grafts will contract over time resulting in further complications. However, possibly the greatest drawback to the procedure is the cost involved. Alloderm is extremely expensive and typically U.S. $3000 worth of material is needed. Unless the cost of the material falls dramatically, the procedure will no doubt remain out of the reach of many men considering surgery.
Summary:
As you can see, surgical enhancement techniques are constantly involving and quite a few advances have been made in the last ten years. There is no doubt penis enlargement surgeons are becoming increasingly skilled and the chances of things going drastically wrong are now much reduced. In the early days of penis enhancement surgery, many men suffered horrific deformities as a result of the surgery. Loss of sexual function, misshapen penises, infections and painful scarring were all possible consequences. Lawsuits abounded and men often spent considerable sums of money on further surgery in an attempt to have their penises restored to their preoperative condition.
Whilst techniques have advanced and there are certainly very skilled surgeons in the field, it should be remembered that surgery is not risk free. Complications, although far more remote can still occur and it is still very difficult to accurately determine before surgery how successful or indeed permanent the results will be. If you are seriously considering penis enlargement surgery, it is important to be fully informed of the potential risks and consequences. When not totally informed, many men have unrealistic expectations of what can be achieved and end up being disappointed with the eventual results. You should also strongly examine your own reasons for wanting a larger penis, be they psychological or physical, and then decide whether these reasons justify the potential risks. In order to be totally objective it may be helpful to discuss these issues with both your own doctor and a counsellor.
If you then opt for surgery, consult a number of surgeons and choose carefully. Discuss the surgeon's success rate, ask to see before and after photos and if possible talk to previous patients. A surgeon with a good track record will no doubt be more than happy to put you in touch with previous clients. This gives you the unique opportunity to discuss all aspects of the procedure and the resulting consequences with men who have had first hand experience of both the operation and the surgeon's skills. Also, make sure the doctor is a Board Certified Plastic Surgeon, request to see diplomas and enquire about any further qualifications the person may have. A Board Certified Urologist for example, will have specific in depth training and experience involving male genitalia. Whilst such a qualification is not essential, finding a surgeon who has performed a large number of successful procedures and who is prepared to openly discuss all the possible consequences, both positive and negative is fundamentally important. A well respected surgeon with extensive experience in the field will no doubt offer a greater chance of achieving permanent gains and will have the required skills to minimize risks or resolve postoperative complications should they occur.