Mainstream Urology Center for Men's Sexual and Reproductive Health

Current Status of Penile Augmentation

There has been much controversy in the newspapers and magazines recently about surgical procedures to augment both the length and width of penises. The controversy is based on the fact that many physicians feel that patients are being charged enormous prices for a procedure that has no scientific validity.

Most urologists, including a specific conference held at the 1994 American Urological Association national meeting in San Francisco and the Society for the Study of Impotence, have taken the stance that men with a normal and functioning penis have little or no justification for trying to augment the size or length of their penis. On the other hand, the physicians, both urologists and plastic surgeons, that are doing the operation, claim that the procedure is safe and effective and have had excellent results.

What Is Involved?
There are two aspects to the operation as described. One is penile lengthening and the other one is girth or width enhancement.

How Are Lengthening and Girth Enlargement Accomplished?
Penile lengthening operations require a skin incision at the base of the penis as it joins the body just below the pubic bone. The incision is continued down to the shaft of the penis where a special band or 'suspensory' ligament holds the penis up to the pubic bone. By cutting the suspensory ligament, the penis is allowed to fold down, thereby adding some length to the non-erect penis.

Girth enlargement is accomplished by injecting fat underneath the skin of the penis. The fat is taken from other parts of the body, usually the abdomen.

Patients may opt for either lengthening or girth enlargement, but most of the surgeons that do the procedure say that most patients ask for both procedures to be done simultaneously.

Lengthening
Historically, lengthening procedures have been attempted for patients, usually children, with particularly short penises with hopes of gaining some length of the unerect penis. There are no historical conditions for which girth enlargement has ever been used. The question and controversy, of course, is whether the penis is actually really longer. The physicians who are promoting these procedures claim that the penis may increase in length from 1 to 3 inches, with the average being 2 inches. Using the same techniques, the physicians who claim poor results suggest no more than 1/4 inch is gained in length in most patients. The truth, as often is the case, lies somewhere in the middle. The controversy is probably not whether the penis is actually lengthened as most interviewed feel that there actually some length gain, but whether the modest gain in cosmetic length warrants the risk of the surgery.

Untoward Side Effects of Lengthening Procedures
There is a technical possibility of an uncircumcised foreskin not covering the head of the penis.

There is the possibility of losing the normal angle of erection when the suspensory ligament has been cut. (that is the penis, although erect, will not 'stand up').

There is a possibility of scarring on the penile shaft.

Undesirable hair growth on the penis because of the skin grafts that are needed to make up the skin gaps over the suspensory ligament.

Most experts agree that the increase in penile length is only in the flaccid or unerect state, and that with an erection no length at all is gained.

Girth Enhancement
The girth enhancement (increase in width) as mentioned above comes from the injection of fat grafted from one part of the body into the shaft of the penis. This is done by suctioning fat into a syringe and then injecting the fat under the skin of the penis.

Augmentation
Most of the research has suggested that the fat injections will dissolve within six to eight months. Occasionally small areas of 'fat encapsulation' or hard fat nodules will occur which can give a lumpy texture to the penile shaft. There seems to be fairly good initial results, but the long-term results seem to be more inconsistent and unpredictable.

Patients who desire to have augmentation must clearly understand that initially there will be a fullness and swelling of the areas of the transplanted tissue, and that multiple or additional procedures may be required to maintain the desired girth enhancement and to smooth out any irregularities.

Conclusions
It is possible that only the lengthening procedure has any significant promise for men, and this is probably only in the area of lengthening the flaccid penis. The psychological aspects of this are probably more profound than the actual physical aspects, and in that sense, penile lengthening is similar to other surgeries such as facelift and nose repair for cosmetics only. Clearly there is much concern about penis size in terms of our culture, and the penis size or one's own estimate of his penis size can be a high risk factor for psychogenic problems. Any patient considering a lengthening procedure should consider a psychological evaluation. Done to find out why they really want the operation and to determine what they hope to gain.

There is no published official stand from the Food and Drug Administration, or the national Urology or Plastic Surgery groups for these procedures, other than the comments listed at the beginning of the paper. There is still insufficient data to establish the safety or efficacy of either penile lengthening enhancement or subcutaneous fat injection for increasing penile girth. Whether the psychological benefits of having a slightly longer penis in the flaccid state is worth the risks and aggravation of a surgical procedure is up to each individual patient.

Please do not hesitate to ask us if you have further questions.

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