Penile enlargement and penile thickening are two closely related surgeries that we rarely perform separately.
There are three structures in the penis:
- The penile shaft.
- The skin.
- The musculature.
To achieve a real and definitive increase of the penis, we must act on the three structures.
The penile shaft is externalized by treating its pubic attachments at the level of the suspensory ligament of the penis. The healthy skin is provided by means of healthy skin advancement flaps that allow an increase at rest and erection. The musculature is worked from the internal part at the base of the penis modifying its disposition to allow that with the new relative position between the penis and the pubis the erection is carried out without modification.
At the same time we proceed to the thickening technique that we will perform, generally, by means of the contribution of stem and adipose cells coming from the abdomen.
The first phase of the surgery consists in partially uninserting the suspensory ligament of the penis. The complete disinsertion of the suspensory ligament could allow a greater enlargement but would result in an altered erection angle that would not allow a correct functionality.
This is why in penile enlargement surgery the maximum disinsertion of the suspensory ligament of the penis must be performed while maintaining a correct erection. The amount of ligament we can release while maintaining the erection angle determines the number of centimeters we can extract.
To maximize the extracted penis, we perform a forced erection in the operating room to observe how the penis behaves with respect to the pubis. The other factor that can be limiting in the disinsertion is the presence of large caliber blood vessels in the ligament itself that impede its treatment, although this is infrequent.
A second step will consist of carving a flap, that is to say, to provide the patient’s own tissue to occupy the space created between the penis and the pubis, thus preventing the penis from reattaching to the pubis in some areas and losing centimeters.
An inverted VY skin flap is performed in the skin area. Its design determines the amount of healthy skin that we provide being key to achieve the increase in volume both at rest and in erection.
Regarding the treatment of the musculature, we have a series of points in depth that allow us to push the penis with greater force outward, maximizing the effect of penile enlargement and gain in erection.
Finally we proceed to the multilayer closure, that is, we place stitches in each layer on which we have performed surgery so that we collapse the spaces created seeking to externalize the maximum volume of the penis.