Penis Enlargement Surgery

Surgical procedures to increase penile size (medically referred to as ‘phalloplasty’) have been touted by various specialist surgeons since the late ’80’s.

But despite those thirty years of availability and the continued evolution of surgical techniques, surgery still remains a very controversial option.

Most of the established medical bodies such as the American Urological Association and the American Society for Aesthetic Plastic Surgery for example, still consider the safety and effectiveness of several techniques to be fundamentally questionable.

What’s more, the majority of mainstream plastic surgeons continue to refuse to carry out penis enlargement surgery – particularly when requested as a purely cosmetic procedure – because of the unpredictability of the outcome and the multiple risks involved.

Surgical Procedures

Surgical penis enlargement actually requires two separate procedures, one to lengthen the penis and another to increase girth.

Studies tend to show that better results are achieved when lengthening and girth enlargement procedures are performed independently – generally a few months apart.

Why? Simply because the two procedures conflict each other.

The tissue grafts used to increase penile girth – dermal fat or dermal matrix grafts – are tailored to the patient’s pre-operative penis length.

Consequently, length gains are hindered during recovery as the shorter grafts make it more difficult to stretch the penis through the use of an penis extender (which is an essential part of the post-operative recovery process).

It’s almost like a game of tug of war, with the grafts pulling one way and the penis extender pulling the other.

Likewise, those increases in penis length that are achieved, are made at the expense of the grafts – which can only accommodate the increase in length by being stretched lengthways. As they stretch, they lose much of their thickness just like a block of pastry rolled thinner with a rolling pin.

But despite the fundamental incompatibility of the lengthening and girth enlargement procedures – and probably to spare themselves a second dose of discomfort and recovery – most men tend to opt to have both procedures performed at the same time.

Penis Lengthening Surgery

Surgically lengthening the penis involves cutting the ligaments – called the suspensory and fundiform ligaments – that attach the shaft of the penis to the pubic bone.

These ligaments secure the penis firmly to the pubic bone, similar to a ship moored in port.

However, through another anatomical quirk of the male human body, these two penile ligaments also cause the penis to arch upwards inside the body as the penile shaft passes behind the pubic bone.

In fact, believe it or not, what you see when you look down at your penis is just the tip of the proverbial iceberg.

Another 4 – 6 inches continues behind the pubic bone; first arching upwards as mentioned above, before then splitting into two sections as it attaches to the pelvic floor just behind the scrotum.

By surgically severing the ligaments holding everything in place, in theory some of this internal penile shaft (the arched bit) can be shifted forward into view.

Practical Demonstration

If the above seems a bit incomprehensible, try this:

Bend one of your fingers into an ‘n’ shape – that represents how your penis looks as it follows its path behind the pubic bone.

Now, using your imagination further, pretend the tip of your finger is the visible part of your penis.

What happens when you straighten your finger out? Of course, your finger looks longer.

That’s exactly what happens (in theory at least) when the penile ligaments are cut.

The internal arch of the penile shaft is straightened and consequently, more of the penis is made visible.

Immediate Length Gains

After surgery, it’s not uncommon for men to immediately, but temporarily, gain an extra inch in flaccid penis length.

Immediate gains in erect length on the other hand, tend to be pretty insignificant – maybe a quarter of an inch or so at best.

Essential Use of Traction

One thing penis lengthening surgery doesn’t offer is any form of immediate, permanent gain.

In fact, it’s well documented that many men over the years have been snared into the procedure through the misguided belief – often left uncorrected by surgeons – that surgery offered an immediate quick fix:- the male equivalent of a breast enlargement procedure, where waiting for the healing process to complete is the only inconvenience.

Nothing however, is further from the truth.

As those who have fallen prey to the fallacy can testify, they often haven’t just been left disappointed with minimal increases; they’ve ended up with a penis shorter than their pre-operative length.

That’s because in reality, permanent increases in penis length are only made in the 3 – 6 months following surgery through an intensive regime of daily penile stretching.

Reputable surgeons generally recommend that patients stick to a daily penile traction regime of at least 8 hours if they want to realise permanent gains.

As one of the most eminent surgeons in the field, Dr Harold Reed put it:

If a patient tells me that he’s been stretching his penis for 7 hours a day, I tell him he’s just wasted 7 hours a day.

This need for a high intensity penile traction regime stems from a basic problem with all forms of surgery: the development of scar tissue during healing; which thanks to its highly inelastic nature, tends to lead to tissue contraction within the healing surgical incision.

In the case of the penis lengthening procedure, internal scar tissue develops in the incision made to cut the penile ligaments; and as it develops, the penis is effectively pulled back into the body.

The only way to mitigate the negative effects of this tissue contraction is through that minimum 8 hour daily traction regime.

Long Term Length Gains

For those who do have the motivation to continue stretching, a maximum increase of about an 1/8 inch a month can be expected.

So after 6 months of daily stretching, if all goes well, and you stick rigidly to your traction routine, you could expect to gain under an inch in erect length.

Clinical studies

Medical researchers who’ve independently examined the effectiveness of penile lengthening surgery report similar findings.

For example, a review undertaken by researchers at St. Peter’s Andrology Centre and Institute of Urology of 42 men who’d undergone the procedure between 1998 – 2005  found the following:

  • An average long-term erect length increase of 0.5 inches / 1.27 cm
  • Around 5 percent of men experienced permanent penile shortening of 1 cm
  • The procedure had an overall patient satisfaction rate of 35

In conclusion, the study reported:

Division of the penile suspensory ligament or other augmentation techniques may increase penile length but usually not to a degree that satisfies patients.

Another study published in European Urology Journal in 2005 reported similar.

In this study of 11 men between the ages of 25 – 35 who’d opted for penis enlargement surgery, urologists from Athens Naval and Veterans Hospital reported:

  • An average penile length increase of 0.6 inches / 1.6 cm
  • A maximum improvement of 0.9 inches / 2.3 cm
  • Average girth increases (from simultaneously performed girth procedures) of 0.9 inches / 2.3 cm at the base of the penile shaft; 2.6 cm behind the penile head.

Complications with Lengthening Surgery

Apart from the high level of commitment you need to make even modest gains in erect length, the lengthening procedure has several potential drawbacks.

Once the suspensory ligament has been severed, the penis is no longer firmly secured to the body. Because of this, the unanchored penis has a tendency to slip and shift during sex, and this continuous jarring can potentially lead to injury.

Cutting the suspensory ligament can also produce a number of noticeable visual negative side effects.

Without the support of the suspensory ligament, patients usually experience a significant loss in the angle of their erections. Instead of pointing upwards, their erections struggle even to point straight ahead, and are sometimes left even pointing downwards.

Less frequently, the penis sinks downwards into the scrotum. Not only does this result in the penis taking on a rather noticeably abnormal positioning, but the base of the penis becomes enveloped by large flaps of skin – a condition often referred to as ‘scrotal dog ears’.

In 2006, researchers from the Department of Andrology, Sexology and STDs, Cairo University, Cairo, Egypt reviewed the available medical literature on penile enlargement surgery – covering both length and girth enlargement procedures.

In the study they concisely cover the potential complications of both the lengthening and girth enlargement procedures – including the complications mentioned above.

The Non-Surgery Traction Paradox

The whole theory behind surgically cutting the penile ligaments is that it enables the internally held part of the penile shaft to be gradually pulled outwards. Something, that as we’ve already seen, is only achieved through a post-operative penile traction regime – which involves a minimum of 8 hours of traction per day over the following six months.

Keep this up and you’ll achieve, according to the medical data, somewhere between 0.5 – 1 inch / 1.27 – 2.54 cm in erect penis length.

But as we’ve seen, whilst cutting the ligaments might help the lengthening process in theory, there’s a monumental stumbling block.

The unavoidable scar tissue that forms in the pubic incision that has to be made to cut the ligaments has a counteractive effect. As it contracts and shrinks – as scar tissue does by nature – it pulls the penis back towards the body.

It’s like a tug of war between the patient trying to stretch the penis through traction, and scar tissue dragging it back again. And it’s game of tug of war that the scar tissue tends to win if a traction routine isn’t used – often resulting in a shorter penis.

But what happens if the penile ligaments aren’t cut, and instead traction is used on its own as an entirely non-surgical method of penis enlargement?

With the numerous pitfalls of surgery, it’s a question that an increasing amount of medical research has focused on in the last few years; and one where the answer seems remarkably encouraging.

For example, take the findings of a study published in the British Journal of Urology in March 2009.

Researchers from San Giovanni Battista Hospital, Turin charted the progress of 15 men who instead of having surgery, simply used a penile traction device on its own – 4 hours per day over six months.

At the 12 month follow up (six months after the patients had stopped using traction) the research found that:

  • The average gain in flaccid penis length was 0.9 inch / 2.3 cm
  • The average gain in stretched length (equivalent to erect length) was 0.65 inches / 1.7cm
  • This translated into a percentage increase of up to 32 percent in penis length
  • The use of traction was accompanied with a high overall patient satisfaction rate of 2.8 out of a scale of 0 – 4.

The concluding remarks of the study read:

Penile extenders should be regarded as an effective, minimally invasive treatment option to elongate the penile shaft in patients seeking treatment for a short penis.

This sentiment was reflected in a later medical paper, published in the British Journal of Urology in 2011. Here, researchers reviewed the data from multiple studies conducted between 2000 – 2009.

They found that across all the reviewed studies, the average increase in penile length from using a traction device on its own was 0.7 inch / 1.8 cm.

They concluded:

Results achieved do not seem to be inferior to surgery, making these traction devices an ideal first-line treatment option for patients seeking a penile lengthening procedure.

When you consider that the average increase in erect penis length from surgery and traction combined is 0.5 – 0.6 inch, compared to 0.65 – 0.7 inch  when traction is used on its own, it’s understandable why such studies are suggesting that penile traction without surgery should be the favoured treatment option.

All this combined data reveals a few things of interest:

  • The penile ligaments do not need to be cut through surgery to accommodate length gains. They are highly elastic; and consequently are capable of being effectively stretched.
  • The length gains achieved through penile traction are at least equal to those achieved through surgery, and are often better.
  • The surgical lengthening procedure in good in theory, but it doesn’t work as well in practice. Scar tissue contracture following surgery has a significantly counteractive effect that limits much of the potential positive effects of cutting the ligaments.
  • Much of the traction process following surgery – 8 hours per day over 6 months – acts purely to limit the counteractive effects of scar tissue formation. This is born out of the fact that without the use of traction, patients often experience no length increase, and sometimes even end up shorter following surgery.
  • Without the scar tissue tug of war to contend with, traction used on its own – without surgery – has a far easier time lengthening the penis. So much so in fact, that comparable gains in length can be achieved through a daily traction routine of just 4 hours over 6 months. That’s half the amount of penile traction that’s required following surgery to make the same gains.
  • The consensus from researchers seems to be that penile traction, not surgery, is the best first-line treatment; offering similar potential length increases to surgery, but without the associated complications.

Penis Girth Enhancement Surgery

There are several techniques used to increase penis girth. These procedures have evolved one after another in an attempt to overcome the shortfalls of previous techniques.

Fat Transfer

The first girth enhancement procedure to be developed in the early 1990’s was Fat Transfer. Even though there are more sophisticated procedures available, it remains a very commonly used technique.

Fat Transfer involves taking fat cells from the abdomen or inner thighs through liposuction, purifying the cells and then injecting them directly beneath the penis skin.

Although initially this can produce gains of 30-50 percent in penis girth, long-term results are very unpredictable. The fat cells tend to be easily reabsorbed back into the body, and the added girth is always at least partially lost. To complicate things further, the cells sometimes reabsorb unevenly – leaving a lumpy, uneven appearance to the penis. Further fat injections may help to even out the appearance, but there is always a risk some asymmetry will remain.

Another common complaint is not so much about the look of the penis, but about the feel. Men often state that during an erection, the fat cells feel much softer than the hard erectile tissue underneath – in fact, it’s often said that the injected fat feels very much like breast tissue.

Dermal Fat Graft Augmentation

To overcome these problems, a more advanced technique called Dermal Fat Graft Augmentation has been developed.

This procedure involves removing two strips of tissue (consisting of skin and under lying fat) from the crease of the buttocks, and then grafting these strips beneath the skin of the penis. Because the grafted skin prevents the underlying layers of fat from being reabsorbed, this technique tends to produce much more permanent and stable results.

The main drawback with this technique is that sizeable incisions are made to obtain the grafts – each one about six inches long and two inches wide – and it is impossible to know how these incisions will heal. In some cases, they heal to form barely visible hairline scars, but in other cases far more prominent and visible scarring develops.

Alloderm Grafts

In order to remove the need to take tissue grafts from the patient, the latest development has been to use grafts made from a product called Alloderm.

Alloderm is actually cadaver skin i.e. skin from dead humans, which has been treated to remove any diseases and then freeze-dried. Just like dermal fat grafts, Alloderm is layered around the penis to build up the desired girth.

Alloderm seems to produce similar results to Dermal Fat Grafts with the added bonus that visible scarring is avoided. But this advantage comes at a price. Alloderm is extremely expensive and around $3000 of the material is usually needed, which knocks up the cost of a typical girth enhancement operation to around $8000.

Complications with Grafts

Both Dermal Fat Grafts and Alloderm do seem to produce much better results than Fat Transfer, but again complications can occur. With both procedures it’s still possible that some reabsorbtion will take place, leading to a loss in girth. It’s also possible for the grafts to shrink over time or for parts not to survive. In these cases, penis shortening or asymmetry are both possibilities.

Summary of Penis Enlargement Surgery

The most important point to note about penis enlargement surgery is that it definitely isn’t a miracle solution. Stretching your penis for at least 8 hours a day for six months just to gain an inch is a tall order, and definitely takes a lot of dedication and commitment.

And with all types of surgery there’s also the chance of infection, bleeding, bruising and scarring. Combine this with the specific risks associated with these procedures and you’re taking a serious gamble with the health of your penis.

As far as cost is concerned, lengthening on its own will set you back around $4500. If you combine this with girth enhancement you’re looking at $10,000-$12,000. That’s certainly a lot to fork out for an unpredictable operation that almost all urologists and even many plastic surgeons do not recommend.

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