So You Want A Bigger Penis??

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Complications

Many of the previously quoted studies do not discuss complications. Penile enhancement surgery is a highly risky procedure. There is no standard surgical technique, and much of the performed procedures are experimental with minimal objective pre- and postoperative data. In patients who have autologous fat transfer for girth enhancement, complications include loss of injected fat and irregularity at the injection site, scar thickening with keloid formation and scrotalization.[46,47] These complications are usually seen when the V-Y flap techniques is employed.[46,47] Sexual dysfunction and further penile shortening are also reported complications of these penile enhancement procedures.

In 1997, Alter[46] nicely reviewed the complications from penile enhancement surgery. Alter reoperated on 19 men over a 2-year interval, all of whom had penile enlargement surgeries by other physicians. In all 19 men, cutting the suspensory ligaments and advancing the skin in the V-Y advancement flap was performed in an attempt to achieve penile lengthening. Penile girth enhancement was accomplished by autologous fat injections. Patients presented various complaints such as hypertrophic scars, low hanging penis and penile lumps. In 12 of 19 patients, either complete or total reversal of the V-Y advancement flap was performed. In addition, 12 of the men had removal of subcutaneous fat nodules. Alter attributed most of the poor results to flap viability secondary to vascular supply, or to a thick V-Y flap. Often a complete reversal of the V-Y flap was either impossible, or undesirable. Elevation of the V flap was performed, aligning hair-bearing skin on the flap to the scrotum to maintain blood supply and scrotal dog ears were excised.[46]

Discussion

This review gives an overview of studies that examine the average length of the penis, conditions that result in penile shortening and penile enhancement procedures.

Variability arises between standardization of penile measurements. Objective standardization is required to make comparison of data more accurate. Penile length should be measured from the base of the penis, or the pubopenile junction at the most proximal point to the tip of the glans as the most distant point of measurement. Penile length should be evaluated in three states: flaccid, flaccid stretched and erect, whereas penile girth or circumference should be measured as flaccid and erect. In order to accurately reflect penile size, both length and girth measurements should be taken in all states. These measurements should be made by a single health professional, not with self-reported questionnaire data. With the exception of Wessells' data,[5] no study performed measurements under all conditions. Rather, measurements were recorded in either the flaccid state or the erect state, but never in both. Given the tremendous variability in penile size and the unpredictable penile extensibility, it would appear that penile measurement should be performed in all states in order to arrive at a consensus statement regarding penile size.

Why perform penile enlargement surgery? Is the motivation of the patient purely for cosmetic and psychological reasons or is there a bona fide medical need/condition to warrant or justify penile enlargement? With respect to those patients seeking enlargement for the former reason, there is no medical necessity to perform the surgery. This is usually true with cosmetic plastic surgery for women for breast augmentation when not associated with breast cancer. Is this type of surgery reasonable in men with respect to penis length? Should the surgeon consider psychiatric clearance prior to consideration of penile augmentation surgery? Should this be the standard of care?

There are medical conditions that result in legitimate penile shortening. There is evidence that some of the current treatments for prostate cancer, can lead to penile shortening. Specifically, men who undergo radical prostatectomy and possibly radiation therapy and hormonal treatment are susceptible to penile shortening.[15-17] Although penile shortening has been documented, there is no quality of life data to support or refute the overall importance of this effect on male sexuality. Along similar lines, patients who have peyronie's disease are also subject to penile shortening, but much like those treated for prostate cancer, penile shortening is not usually significant enough to warrant enlargement surgery.

Surgeons who consider performing this type of surgery must be able to justify why enlargement surgery should be performed. This discussion should first include the distinction between those procedures that increase penile girth and those that are aimed at increasing penile length. Regardless of which type of procedure is being sought, the patient should be aware that there is no universally accepted protocol for either type of surgery. Most of the reported case studies have been in a small experimental population with short followups. They should also be informed of the numerous complications that can result from such procedures, which included but are not limited to poor cosmesis, further shortening and sexual dysfunction.

Plastic surgical procedures on the skin of the penis holds more optimism. It appears that the overall risks of these procedures are minimal. Quality of life data collection will be necessary to determine if the value of these procedures approach that of breast augmentation for women.

Conclusions

The issue of penile size is one that will forever be an area of controversy for most men. This review sheds some light on the objective data regarding penile size. To reach a true consensus of penile size, a study comparing men from different races and nationalities would need to be performed. Standard measuring techniques are necessary to determine the results of penile lengthening procedures. We have sufficiently demonstrated medical and surgical conditions in which penile shortening occurs. In addition, we have highlighted the procedures that are currently being performed for penile lengthening, girth enhancement and plastics skin reconstruction, and their associated complications.


Submitted by DMorgan on Sun, 01/18/2009 - 9:21pm.