Long Term Results in Augmentation Phalloplasty through a 2-cm Incision: Technique, Anatomical Description in a Human Cadaver and Satisfaction Assessment

Abstract

Objective: An increase in the length of the penis is feasible with techniques that either divide the penis’ ligaments (fundiform and triangle) or use grafts to increase the size of the corpora. Girth enhancement can be done with fat autoinjection or with dermal grafts. We present our technique together with an anatomical description in a human cadaver. Patients and Methods: Forty patients underwent augmentation phalloplasty. To increase the length of the penis the ligament was divided through a small 2-cm incision at the base of the penis. Girth enhancement was achieved through fat autoinjection with fat taken from the inner thighs. The dissection of the ligament was also demonstrated in a human cadaver to allow for more explicit presentation of the anatomy of the area. A questionnaire was used to assess the patients’ satisfaction. Results: Before operation all patients had a normal penis with a length 9.5 ± 2.2 cm (8.1–13.5 cm) in the flaccid state and 11.8 ± 1.9 cm (10.9–17.2 cm) in the erect state. The mean circumference was 9.9 ± 2.3 cm (7.6–11.8 cm). The increase in length 12 months post-operatively was 3.5 ±1.3 cm (2.3–5.1 cm) in the flaccid state, 1.8 ± 1.4 cm (1.4–3.2 cm) in the erect state and 3.5 ± 1.4 cm (2.1–5.2 cm) in girth. There was a statistically significant difference (p < 0.005) between pre-operative and post-operative status. The overall satisfaction rate was 67.5%, and 57.5% of the patients stated that the surgical outcome met their pre-operative expectations. Conclusion: Penile lengthening is technically possible provided that some basic principles are followed. Psychological disturbance though, might be present and such patients might not be pleased even after a successful operation.