Up-to-Date Surgical Techniques for Penile Augmentation with AlloDerm

Abstract

Introduction: Today, a man is capable not only of understanding his own nature and anatomy, but also of altering it. Specifically, surgical penile augmentation (phalloplasty) is available to enhance the length, girth, and glans of the penis. This article describes several modern phalloplasty surgical techniques. Materials and Methods: A total of 374 phalloplasty surgeries using AlloDerm were reviewed for this article. These surgeries were performed by 2 surgeons over a 5-year period in multiple surgery centers. AlloDerm is a cadaveric, acellular, tissue-regeneration matrix that is processed from donated human skin. To create AlloDerm, a free human cadaver skin graft (allograft) is minimally processed to remove epidermal and dermal cells, while preserving the remaining bioactive components and structure of the dermis. The resulting graft serves as a framework to support cellular repopulation and vascularization. In phalloplasty surgery, this graft is used to enhance the length, girth, and/or glans of the penis in the male cosmetic surgical procedures described here. Results: Seventy-four percent of the patients who underwent the phalloplasty procedures with AlloDerm and participated in the postoperative survey reported great satisfaction with their male cosmetic genital surgery. Complications: Serious infections that required surgical treatment developed in 12 (3.2 %) of these patients. In 7 of these patients, the infection was cured after 2 weeks of continuous treatment with general and local antibiotics. The patients were successfully signed off from the treatment with subsequent instructions regarding continuity of care. In the remaining 5 patients, the AlloDerm required removal in order to successfully treat the infection. In addition, 18 patients (4.8%) experienced localized swelling 7 to 10 days after surgery. This swelling resolved spontaneously. Finally, 16 patients (4.3%) reported postsurgical retraction that was successfully treated medically and surgically. Discussion: Today, a man can modify the size and shape of his penis using procedures introduced by cosmetic/plastic surgery. With the use of AlloDerm, these changes can last for years, and could be considered almost permanent. In the future, AlloDerm may be replaced by artificial tissue, by engineered material, or by human penis cells cultured and grown for use as a natural matrix. In 2000, Buvat and Lemaire wrote the following: “Penile lengthening and augmentation surgery is attracting more and more men. Nevertheless both its objective results and ethical implications are debated. Indications and operative strategies as well as the assessment of the results seem little standardized, while many candidates [for] this type of surgery have in fact a penis in the normal range of size.” In 2003, the American Academy of Phalloplasty Surgeons established international standards for male cosmetic genital surgery, including the identification of indications, operative strategies, surgical techniques, and the assessment of results. These standards have been in effect for 5 years, and when qualified surgeons have followed them, these surgeries have been successful. Yet, despite successful physical results, the subjective evaluation of aesthetic results and the ethical implications of male cosmetic genital surgery continue to be debated. Conclusion: This article represents the first published retrospective evaluation of patients who have undergone surgical penile enlargement with AlloDerm. The study reported a high satisfaction rate with a new surgical technique for penile augmentation (Penile Triple Augmentation™) developed and used by the author of this article.