Sir: We read with great interest the recent article of Dr. Alter entitled “Pubic Contouring after Massive Weight Loss in Men and Women: Correction of Hidden Penis, Mons Ptosis, and Labia Majora Enlargement.”1 Although men represent a smaller percentage of the massive weight loss population seeking pubic contouring surgery,2–4 the excess volume and skin in the pubic pouch is troublesome to the male patient and needs the attention of the body contouring surgeon. We most certainly agree on the techniques described by Dr. Alter to correct and stabilize the hidden penis, but we would like to present some alternative techniques for correction of the pubic pouch. In most cases, excision of a horizontal ellipse and suspension of the superficial fascia layer to the rectus abdominis muscle fascia is indeed sufficient. It is, however, our experience that excessive suspension in an attempt to correct large deformities may result in tight internal scarring, resulting in discomfort when the patient has an erection. The large pubic pouch deformities may therefore benefit from vertical wedge excision techniques, as have been described for monsplasty in the female massive weight loss patient.4,5 Those techniques include excision of a central vertical wedge, which often results in somewhat unsightly dog-ear formation inferior to the scar (i.e., just above the base of the penis). Moreover, because monsplasty in the male massive weight loss patient is often combined with fleur-de-lys abdominoplasty, excision of this central vertical wedge inevitably results in a crossroad of four scars that is prone to break down. We therefore started excising two lateral vertical wedges at the border of the pubic pouch (Fig. 1). The benefits of this procedure are the reduced dog-ear formation inferior to the excised triangles, better flattening of the mons because of lateral pull on both sides, and having the monsplasty scars away from the vertical part of the fleur-de-lys abdominoplasty scar (Fig. 2).Fig. 1: Preoperative markings for lateral vertical wedge excision technique for monsplasty.Fig. 2: Postoperative result of a patient 8 weeks after surgery, with nice flattening of the mons and inconspicuous vertical scars.Because these vertical wedge excision techniques can be combined with the traditional horizontal excision techniques, the more severe cases of overhanging pubic pouches can be corrected. We have found this to be a very effective way of dealing with the pubic region and would like to stress the importance of addressing the pubic region in male massive weight loss patients. DISCLOSURE The authors have no financial disclosures to declare. Benoit Hendrickx M.D., Ph.D. Morris Ritz M.D. Melbourne Institute of Plastic Surgery Malvern, Victoria, Australia
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Oct 12, 2017
Neil S Sadick 
Open Access