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Original Article Plastic and Aesthetic Research

Composite augmentation phalloplasty:

personal experience after 275 patients

Juan Monreal

Consultant Plastic Surgeon, Hospital Moncloa, Avenida de Valladolid, 83, 28008 Madrid, Spain.
Address for correspondence: Dr. Juan Monreal, Londres, 54-1ºD, Torrejon de Ardoz, 28850 Madrid, Spain. E-mail: juanmonreal@gmail.com

ABSTRACT

Aim: To report the author’s experience in augmentation phalloplasty by studying a retrospective
series of patients who underwent fat grafting for girth enhancement or a composite technique based
on suspensory ligament release plus fat grafting performed simultaneously. Methods: The author
analyzed retrospectively the outcomes of 275 augmentation phalloplasty procedures performed in
259 patients until November 2013. Of these, 127 correspond to girth augmentation with fat grafting
and 148 to composite augmentation phalloplasty (girth augmentation with fat grafting and length
improvement by suspensory ligament release). In 16 patients girth and length enhancement were
performed in two separate procedures. Results: Of this 259 patients, 87 underwent postoperative
follow-up for at least 12 months and 160 patients underwent follow-up for at least 6 months. The
average increase in circumference at 6 months was 1.7 cm (1.57 cm at 12 months) and the average
increase in length of 3.2 cm (3.1 cm at 12 months). Twenty-two patients showed minor complications
that were treated without sequelae and without influencing the final result. Conclusion: By judicious
use of currently available techniques, it is possible to achieve stable increases in penis size. The use
of composite techniques provides better final results than the use of individual techniques performed
alone due to the increase of the actual volume of the penis. An adequate informed consent is essential
in all patients due to the unrealistic expectations expressed by the majority of them.

Key words:
Adipose tissue, fat grafting, lipofilling, penis augmentation

INTRODUCTION limitations, and what results they can expect. Although
a large number of patients who are interested in genital
One of the traditional benefits that aesthetic surgery aesthetic surgery request a consult for purely aesthetic
offers to patients is the improvement in self‑esteem. motivation, as in other domains of aesthetic surgery, there
The appearance of the external genitalia, both male and are many in which a functional defect coexists with the
female, can have similar degrees of influence on social aesthetic burden that can worsen patient experience in
relationships and may cause a concern similar to that sexual or social relationships.
generated by a lipodystrophy or a nose with inadequate Generally speaking, aesthetic surgery of male genitalia is
proportions. Given the unrealistic expectations (sometimes focused on increasing penis measures in both length and
fanciful) that these patients tend to assume about girth. There are, however, ancillary techniques that work
the anticipated results, it is essential to properly and
thoroughly inform patients about treatment characteristics, to improve the “visual” size of the penis and scrotum. At
the present time, there is only one technique capable of
increasing girth in erection but none (at least known to
Access this article online the author) capable of increasing dynamically the length in
Quick Response Code: erection. Therefore, currently, existing techniques are able
Website: to increase the girth in erection or flaccidity but not both.
www.parjournal.net
There are surgical techniques that increase the length in
the flaccid state, but no reports known to the author that
DOI: describe increasing the length of the penis in erection.
10.4103/2347-9264.149374 For these reasons the enhancement of the penis size is
better achieved by performing several surgical techniques

Plast Aesthet Res || Vol 2 || Issue 1 || Jan 15, 2015 27