Penile augmentation (also known as phalloplasty, penile enchancement, penis enlargement) is intended to increase the size of a penis, offering patients enhanced confidence and sexual pleasure. Penis enlargement surgery consists of two surgical procedures to enlarge the penis, one is used to increase the girth of the penis, the second is used to increase the length of the penis. Typically, patients opt to have both penis enlargement procedures carried out at the same time. 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?
Lengthening procedures are performed under general anesthesia. Incisions are made at the root of the penis where it joins the pubic area. The penis is then released from its attachments (suspensory ligaments) to the pubic symphysis. The space is closed with local tissue. Skin from the penis and/or the pubic area is used to cover the new extended penis. Post-operative traction using weights reduces the chance of retraction and provides more natural shaft skin.
Increasing the girth of the penis relies on fat cells (usually from the patients gluteal region) being transplanted (injected) around the penis. The procedure, known as fat transfer, bulks-up the penis and can increase the girth of the penis by 1 to 3 inches. A variant of the fat transfer method called "dermal transfer" strips of skin and fat together. The skin stops the fat from being re-absorbed into the body but because this procedure requires strips of skin and fat to be grafted onto the penis the surgery is more complex and the risk of disfigurement is much greater.
It can take 40 minutes to 2 hours to perform penile enlargement surgery. Time requirements vary depending on the method of the surgery being used.
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/email 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.
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.
The signs and symptoms of Peyronie's disease may appear overnight or develop more slowly. These may include:
Peyronie's disease causes an uncommon sexual dysfunction that results from a bent penis during erection. The disease is characterized by a hard, fibrous layer of scar tissue (plaque) that usually develops under the skin on the upper or lower side of the penis. When the penis is erect, the scar tissue pulls the affected area off at an angle, causing a curved penis. The plaque, formed by thickened layers of erectile tissue, is noncancerous (benign). Francois de la Peyronie, a French surgeon, first described Peyronie's disease in 1743.
- Painful erection
- A bend or curve in your penis during erection
- Inflammation under the skin of your penis that develops into hardened scar tissue
- A thick band of hard tissue on one or more sides of your penis
- Narrowing of the diameter of your penis during erection
- Impaired ability to obtain an erection (erectile dysfunction)
Scar tissue that develops on the top of the penis will cause the penis to bend upward. Plaque on the underside of your penis will cause it to bend downward. More rarely, hardening may occur on both sides of the penis, causing indentation and shortening. In many cases, pain caused by Peyronie's disease may decrease after a short period of time. However, the curvature may persist even if the pain subsides. In some men with a milder form of the disease, inflammation may improve without causing a lot of pain or permanent bending. Peyronie's disease can make intercourse painful, difficult or even impossible. Emotional distress can put a strain on your marriage or relationship and make attempts at sexual activity with your partner stressful and frustrating.
What are the Causes:
Doctors and researchers don't completely understand what causes Peyronie's disease. A number of theories exist, including:
- Injury to the penis. Trauma to the penis from being hit or bent abnormally while erect or during intercourse may cause small tears in the tissue. It may also cause small blood vessels in the penis to rupture and bleed internally. Abnormal healing can result in the development of hard, thickened scar tissue (plaque) under the skin of the penis. With repetitive trauma, the plaque may develop tough fibrous tissue (fibrosis) or calcium deposits (calcification) and result in the deformity.
- Autoimmune disorder. Some studies suggest that Peyronie's disease may be an autoimmune disorder. A man's immune system may respond abnormally and cause plaque to form in the penis. However, Peyronie's disease isn't related to other autoimmune diseases, such as rheumatoid arthritis or lupus.
- Collagen abnormality. Peyronie's disease may be caused by an abnormality in the substance that builds and remodels connective tissue (collagen).
- Medications. Some drugs list Peyronie's disease as a possible side effect. Most of these drugs belong to a class of blood pressure and heart medications called beta blockers. These drugs are also used to treat glaucoma, multiple sclerosis and seizures. Developing Peyronie's disease as a side effect of these drugs is rare. Check with your doctor before discontinuing any prescribed drug.
Although injury to the penis may explain sudden (acute) cases of Peyronie's disease, cases that develop slowly or disappear quickly with no apparent trauma to the penis remain unexplained. Age, heredity and other conditions involving hardened tissues may increase your risk.
Screening and diagnosis
Doctors diagnose Peyronie's disease by a physical examination. Hard plaque can be felt in your penis with or without an erection. It may be necessary to inject medication into your penis to induce an erection for proper evaluation. Ultrasound of the penis also may reveal fibrous tissue in the penis.
Because the course of Peyronie's disease differs from man to man and some men experience improvement without treatment, doctors often initially recommend a wait-and-see approach. Your doctor may suggest monitoring the progression of the disease for nine to 12 months by assessing plaque formation, penile curvature and erectile function before attempting treatment. Nonsurgical methods include Vitamin E and Intralesional injections.
Common surgical methods include:
If other methods of treatment don't help and your penis is still curved or bent when erect, surgery may be an option. Doctors usually suggest surgery when unacceptable appearance, pain during intercourse and poor erection quality persist for one to two years or longer. Surgery is generally effective at restoring normal erections, although each surgical method can cause unwelcome side effects such as partial loss of erection or shortening of an erect penis.
- Plaque excision. The plaque is removed and replaced with a patch of skin from the pubic area.
- Nesbit plication. Tissue on the opposite side of the penis is removed or pinched, canceling the bending effect.
- Plaque incision with saphenous vein graft. Several linear cuts are made in the plaque, which allows straightening. The cut plaque is then covered with a grafted vein.
- Penile prosthesis. An implanted device is used to straighten and increase the rigidity of the penis