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15 days, patients can start using the traction system if
previously circumcised. In noncircumcised patients traction
must be delayed until foreskin swelling has disappeared.
The author recommends the use of an extender [Figure 6]
because it ensures control over initial scar maturation and
helps to prevent ligament reattachment. In addition, when
used correctly, additional length is added to that offered a b
by the surgical procedure. All patients are encouraged
to maintain sexual abstinence during the 1st month
postoperatively.

RESULTS

Of the 259 patients who underwent surgery, 160 provided c
a 6 months follow‑up and 87 completed 12 months of d
follow‑up. In 99 patients follow‑up was < 6 months. The Figure 7: Case 1. preoperative and 11 months postoperative views
of composite augmentation phalloplasty (40 mL of fat). (a and c)
average increase in girth was 1.7 cm at 6 months and Preoperative; (b and d) 11 months postoperative
1.6 cm at 12 months and the mean increase in length
was 3.1 cm and 3.2 cm at 6 and 12 months, respectively.
In 22 patients (8% of the series) the author detected minor
complications that were treated without sequelae and
without influencing the final result. No patient reported
functional problems or difficulty in sexual activity after the
second postoperative month. Postoperative length gain did
not change during the first 6 months of follow‑up. Patients
who used the extender for at least 3 months after surgery a b
achieved modest additional increases in length, which did
not exceed 1.3 cm. The author was not able to properly
analyze the increase in erection measurements due to lack
of data. Figures 7‑9 represent average results of composite
augmentation phalloplasty. Figures 10 and 11 represent
average results of penis girth enhancement with fat grafting.
c d
Minor complications encountered after phalloplasty
were combined infection: marginal wound dehiscence (3 Figure 8: Case 2. preoperative and 16 months postoperative views
of composite augmentation phalloplasty (55 mL of fat). (a and c)
cases, 2%), the development of small seromas that required Preoperative; (b and d) 16 months postoperative
aspiration (5 cases, 3.4%, especially when performing the
suprapubic adipofascial flap), liponecrotic cysts that were
resectable secondarily (4 cases, 2.7% in the first 4 years
of experience). There were no incidents of keloid scar
formation, however, in 5 cases the final scar was considered
hypertrophic. The author currently recommends placement
of silicone sheets or gels as part of the postoperative
care. The use of a postoperative traction system is not
mandatory but helps to minimize the chances of abnormal a b
scarring and to gain extra length. Lack of compliance with
the extender device or the presence of erosion caused by
the pulling ring is a common cause for abandoning the use
of postoperative traction. The author did not encounter
any cases of postoperative paradoxical shortening.
Regarding girth enhancement performed as a stand‑alone c d
procedure, the complications were liponecrotic cysts in
7% of patients (9 cases in the first 5 years of experience), Figure 9: Case 3. preoperative and 12 months postoperative views
of composite augmentation phalloplasty (65 mL of fat). (a and c)
1 case of postoperative infection that needed a complete Preoperative; (b and d) 12 months postoperative
antibiotic course (0.8%), and 1 case of fat overgrowth
due to extreme weight gain (0.8%) [Figure 12]. Lack DISCUSSION
of abstinence, especially during the first 2 weeks, can
certainly cause the loss of grafted fat to some degree, so Standard measurement of the penis has been a
the patient should be warned about this. controversial issue and a subject of discussion

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