The most notorious of all the penis enlargement or augmentation methods is probably a surgical procedure. Penis surgery has had a tremendous development in the last decades and nowadays many different procedures are available, but most of them still have many dangers and disadvantages involved. In general, it is much easier to make the penis thicker than longer, and the success of such operations is far more effective and successful.
The main procedures include:
The techniques of the first group are based on inserting (injecting or implanting) some material under the penis skin or into the penis and scrotum to increase its volume (mainly girth). These materials can be artificial (silicone; poly methyl methacrylate - transparent thermoplastic, known as acrylic glass or Plexiglas, etc.) or biological tissue such as treated donated flesh or fat which is normally autologous - the donor is the patient him-self (if it is fat, this kind of procedure is called lipofilling). Some of these implants (such as silicone) have a secondary function of weighting down the penis slightly to induce stretching.
The hard or semi hard artificial implants can be removed, whilst the biological materials (flesh, fat) are absorbable by the body, thus diminishing the effect of the treatment over time (for instance the majority of injected body fat is reported to be absorbed by the body within a year after treatment).
Although, generally considered relatively safe and effective, this kind of methods can also have unwanted outcomes. Side effects include: loss of sensation, inability to perform penetrative intercourse, scarring, deformation and in some cases even shrinking of the penis is reported.
The latest development in this field is using biodegradable scaffolds to engineer tissue. This method leaves no residual foreign tissue in the penis after the re-absorption of the scaffold. It is stated as a new, better approach with reasonable safety, reproducibility, better appearance results and low occurrence of post-operative complications.
To attain length two methods are available: real lengthening of the penis and ligamentolysis. The first one is performed quite rarely and is not a routine or a safe procedure due to high risk of losing the erection ability. It is safe only for treating erectile dysfunction and Peyronie's disease, implanting a penile prosthesis.
Ligamentolysis is a surgical procedure in which the suspensory ligament of the penis which is attached to the pubic bone is cut. The suspensory ligament holds the penis closer to the pubic bone to support it during erection. As one third to a half of the penis is inside the body, this procedure permits the penis to hang out of the body more and thus increases its length outside the body. To asses the length of the penis inside the body prior to operation, echotomography using ultrasound is done which allows inner tissues to be seen.
A post-operative treatment, including stretching of the penis, is usually needed to ensure the ligament will not heal shorter than previously. This is done with a specially adapted penis extender for post-operative treatment. The surgeon decides if and when the extender should be used. Only when the ligament has completely healed in the extended state, the treatment is completed. High risk exists, though, the ligament will not heal properly and the penis will remain hanging unsupported, though it will still have a firm erection.
In reality, this procedure does not make the penis longer; it only allows it to stretch further out of the body.
One of the more radical procedures is to replace the two corpora cavernosa (sponge-like expandable erectile tissues along the length of the penis which fill with blood during erection) with different penile prosthesis (rigid, semi-rigid or hydraulic devices). It is used primarily for patients suffering from severe cases of erectile dysfunction or complete impotence and can not be helped in other ways, or in procedures of constructing a new penis or reconstructing a trauma injured penis.
While rigid and semi-rigid implants make the penis semi-rigid all the time and demand only the adjustment of penis in the desired position, inflatable or hydraulic implants use fluid and can be inflated or deflated on demand. Usually a pump is inserted in the groin or scrotum, and can be manipulated by hand to fill the expansion chambers from an implanted reservoir to achieve erection when desired. The advantage of this treatment is that the erection can last for as long as and be as firm as desired.
The risks of this kind of penis surgery are similar as with other surgical procedures resulting in post-operative complications and unwanted side effects. Furthermore this procedure can not be reversed, as the original tissue is replaced with an artificial implant.
Taking a graft of tissue from somewhere else on the body of the patient (arm, leg, pelvic area under the belly button, etc.), and using it to augment or construct the penis (phalloplasty), is the most radical procedure. The permanent removal of hair from the used tissue is needed (by electrolysis, shaving, depilation or other method), and sometimes toning the skin by tattooing it to achieve the desired color.
This operation is normally followed by a second procedure to implant erectile prosthesis which helps in achieving erection to allow successful penetration (such as rod-like or inflatable medical devices or bone graft etc.). This procedure is manly performed on cisgender and transgender men (transition from female to male), or in reconstructions of trauma injured penises.
The sensation in the newly (re)constructed penis is preserved by connecting the existing nerves in the vicinity and the new tissue which sometimes also develops naturally, but this does not guarantee the ability to reach an orgasm.
Since this procedure requires the lengthening of urethra it is very susceptible to post-operative complications, and there is a risk of the implant eroding through skin with time. Around a quarter of patients had one or more serious complications with the new penis and often a revision surgery is needed to repair incorrect healing. Furthermore, the probability of complications in urethra is in around half of the cases.
Another side effect of this operation is a big visible scar on the part of the body where the graft of tissue was taken from, and possible hindering of the body-partÂ´s functions (for example arm or leg).
The treated patients are generally satisfied to have reached a bigger penis, with the look of the new penis and most of them have good superficial and skin sensation, but on the other hand, only a small percentage have erogenous sensitivity in the new penis (the erogenous zone is usually limited to the base of the penis) and only about half can perform successful penetration without difficulty or pain. In about a quarter of cases a post-operative anti-depression treatment is necessary.
Techniques similar to phalloplasty intended for penis enlargement are also done to help patients with micropenis, although surgical treatment generally does not have big success on its own, therefore it is often accompanied by other types of treatment, such as hormone therapy and penis enlarger or post-operative device treatments.
The future of this procedure is in the transplantation of a laboratory grown penises, but this is not executable yet. There have also been some attempts of penis transplantation from a dead donor, but these have not been successful so far.
After most penile surgical procedures (curvature correction, Peyronie's disease correction, prostate cancer, urological procedures, penis enhancement, etc.) the retraction of penis is a threat, but in all of these cases it can be controlled with the use of an extender device.
To help against penis retraction due to scaring after urological surgery, Andromedical laboratories have created a special medically prescribed Androsurgery extender device. The set includes the device, components for more comfort and protection of the penis and all the guaranties and certifications.