The harmony and proportion between the different parts of the body have also in the noblest organs their reason for being, thus the proper application of techniques for the reshaping of outer genitals by the plastic surgeon who has the required anatomical knowledge, allows healthy people who want to improve their external appearance to acquire self-esteem undeniable benefits, even occasionally, having a direct impact on their interpersonal relationships.
There are wide variations in the shape and size of the penis, however the relevance of its dimensions is a question that has been debated since the dawn of time across multiple cultures, remaining a focus of interest in our days, currently favored by the wide availability of images. The opposite situation that generates frequent insecurities and hesitations in self-esteem, especially when displaying any real or, on the contrary, any subjective lack, such as the changing room complex, is inevitable; these are circumstances that many men have to cope with and bear throughout their existence.
Possible interventions in genital surgery:
Elongation Phalloplasty (Penis Lengthening):
It is performed by partial release of the ligaments that attach the cavernous bodies to the pubis, sometimes complemented by displacements of the pouches of skin or scrotum, and in some cases, by pubic liposuction. The increase achieved may vary according to individual characteristics between 1.5 and 4 cm, but we can sometimes get extra length through the daily use of proper traction, which is maintained after 2 weeks of postoperative care, for 6 months.
There are different approaches in the previous section, so some patients who have been operated by other doctors and have hump deformities at the base of the organ, unwanted irregularities and hair on the back of the penis, in addition to delayed wound healing, which are circumstances that on the one hand, we correct or can redirect, while on the other hand, we prevent by not using techniques that favor these complications.
It should be anticipated that the erection angle whilst standing changes from a preoperative uprighter position to a postoperative less elevated position, although without interfering with the ability to relate.
Thickening Phalloplasty, penis at rest:
There are appropriate techniques for each case in particular, such as fat grafts previously taken from the abdomen or thighs; other doctors use skin and fat grafts or dermal collagen grafts inclusively. The first may atrophy causing distortions, irregular nodules and changes in their consistency. The latter remain greater, although they may result in shortening and curvature. However, the techniques that provide pubic tissue flaps do not have these drawbacks.
We have also applied vein grafts on the cavernous bodies improving the erect penis thickening between 1.5 and 2 cm.
According to the type of procedure indicated and in patients considered suitable, we combine penis lengthening with penis thickening, at rest or even when erect.
Some techniques require a delay of 6 months. Other thickening procedures using foreign materials grafts can change the male organ’s sensitivity.
Most of these treatments may be performed under local anesthesia associated with sedation on an outpatient basis, namely without need for hospitalization, or just a short hospital stay in the morning. Other techniques will require overnight postoperative care. The recovery period depends on the procedure performed, although it may be set between 3 and 5 days, time for more immediate revisions. Sutures tend to be spontaneously reabsorbed. The restoration of sexual relations is delayed until 4 weeks after surgery.
The size issue: we have to establish a maximum in the organ’s dimensions, which is its “constant” variability, in any case, the following normal ranges taken from the scientific literature can be taken into consideration (in no case from alleged racial studies, of dubious methodological rigor):
At rest, the length measured from the dorsal base in the symphysis to the tip of the penis is 10-11 cm, and the circumference at its intermediate portion, 8-9 cm.
When the penis is erect, it is 15-16 cm long and 10-12 cm in circumference.
Correction of concealed penis:
The consequences of excess skin or fat of the pubis and abdomen are more and more frequent being aggravated by radical circumcision in childhood, hindering the location itself, and resulting in invisible penis that even forces you to sit in order to urinate.
There are congenital forms that associate the foregoing to the presence of tissue that retracts inward.
This condition can be improved by liposuction, with or without removal of excess tissues, and by fixing residual tissues at the root of erectile bodies.
Phimosis, primary or secondary treatment, and lengthening of penile frenulum:
In the first case, the tightness of the foreskin, usually from birth, prevents externalizing the glans. In other cases, it can also be acquired by scars. Related complications such as paraphimosis (constriction of the glans by retracted foreskin ring) glans infection and cancer (50% suffering from phimosis) are thus prevented.
We perform foreskin release as conservatively as possible. We can also treat recurrent cases due to insufficient pretreatment and even cases of concealed penis due to aggressive circumcision.
Correction of congenital penile curvature:
It occurs in around 1 in 300 male births.
During erection, deviations to either side are possible, taking into consideration their correction in cases that interfere with acceptable sexual relations. We can acquire their straightening by applying sutures on the convex side.
Treatment of Peyronie’s disease or plastic induration of the cavernous bodies:
The most frequent induration between 40 and 60 years old can promote the formation of a plaque resulting in curved erection and shortening. More than 30% of cases tend to worsen, indicating their treatment when sexual intercourse is difficult.
We get better results by removing the plaque and filling its defects with dermal, vein or thigh grafts. In cases where turgid erection is impossible, implants may be indicated.
Congenital absence of testes, or that may be acquired by subsequent loss:
It is performed by implantation of silicone gel or saline prostheses, the first ones being extremely consistent.
Some males develop over time pendular appearance of the pouches of skin and possible maceration of the skin folds. Correction involves reducing the surplus and restoring normal relations with the penis.
Rehabilitation of ambiguous genitals:
Remodeling is performed in order to allow sexual relations to intersexual patients whose external genitals are insufficiently suited to their personal orientation.
Penile frenulum is a fold that joins the underside of the glans with the inner surface of the foreskin, and helps contract the foreskin over the glans. When the frenulum is too short, we may assume, besides the aesthetic problems, a downward deviation of the tip of the glans or penis. The short frenulum may rupture and bleed during erection causing pain to the patients and even problems in their sexual life, so we recommend this treatment at an early age.
The surgical intervention of the frenulum is very simple and short. It is performed under local anesthesia and involves sectioning the frenulum by extending the distance from the glans to the foreskin.
Other remedial treatments:
Correction of sequels from previous surgery and anomalies in the position of the urethral opening either ventral or dorsal; release of penoscrotal scars or flanges that require new supply of healthy tissue.
In other cases, the intervention seeks to fundamentally redress undesirable consequences of any condition, or previous intervention such as deformities and contractures, ritual, traumatic or surgical mutilations due to previous tumour disease.
TYPE OF INTERVENTION: Surgical
TYPE OF ANESTHESIA: General
AVERAGE SURGICAL TIME: 1-5 h (depending on disease severity)
AVERAGE HOSPITALIZATION TIME: 1-7 days
AVERAGE POST-DISCHARGE RECOVERY TIME: 1-30 days
LEVEL OF SATISFACTION: Very high