Is V–Y plasty necessary for penile lengthening? Girth enhancement and increased length solely through circumcision: description of a novel technique

Abstract

Our objective is to describe a novel ligamentolysis approach using a subcoronal incision technique and to determine its safety and efficacy. During the last 7 years, 82 consecutive patients had penile augmentation surgery. Ligamentolysis, through a lower abdominal incision (V-Y plasty) in the first 35 males, was performed (Group A), followed by circumcision ligamentolysis in the next 47 males (Group B). The operation time, complications, and the preoperative and postoperative values of penile length and girth along with the self-esteem and relations questionnaire score as well as satisfaction score was calculated before and after the surgery, and a comparison was conducted between the groups. The mean age at presentation was 32 years (range: 18-56 years). Seventy-nine patients suffered from penile dysmorphophobia, and three patients had micropenises (length ,7.5 cm). The mean surgical times were 150.7 and 125.2 min for Groups A and B, respectively (P50.005). Postoperatively, four Group A patients and three Group B patients (11% versus 6%, respectively) experienced penile retraction (P50.453). Hypertrophic scars were observed in 18 men (51%) in the former group. In the circumcision group, no major wound complications were recorded. The length and girth improvements between the groups were similar. In terms of satisfaction and SEAR improvement, the resulting difference for both variables favored the circumcision group (P50.007 and ,0.001, respectively). With strict selection criteria, the circumcision ligamentolysis procedure compared to the V-Y plasty demonstrated improved results in terms of safety, operation time, retraction rate and cosmetic appearance without any compromise in the gained penile size. INTRODUCTIONFor centuries, penile size has been a source of major concern and anxiety to the male population. Despite that in the majority of men, penile length is within the normal range, the concern regarding its size may lead to low self-esteem, sexual dysfunction and even psychiatric disorders. The psychiatric term 'penile dysmorphophobia' has been introduced to describe the abnormal perception of penile size, although it has normal dimensions.The majority of patients who request penile augmentation are dysmorphophobic rather than micropenile men.1,2 However, augmentation phalloplasty is not always successful and occasionally leads to penile shortening.3,4 Moreover, the reported satisfaction rates are often poor, which is most likely because the formation of even small hypertrophic scars or keloids for these patients can reduce their inclination for surgery. Therefore, detailed counseling regarding the postoperative results and surgical complications is of utmost importance.5 Several penile augmentation surgical techniques have been proposed, and the most widely performed is the incision of the suspensory ligament (ligamentolysis) combined with V-Y plasty.

A review of penile elongation surgery

“…Penile augmentation with fat grafts also increase the weight of the penis, which can itself increase the length by 2–3 cm ( 35 ). Dermal fat grafting has also been described to increase girth and length of the penis, which may have better fat retention and decreased contour irregularities at the expense of a larger donor-site scar ( 37 , 43 ).…”

“…Division of the suspensory ligament, with or without bulking agent, fat pad excision or V-Y plasty is the most widely accepted surgical technique for penile elongation ( 45 ). The suspensory ligament can be accessed through a V-Y incision or a subcoronary circumcision technique ( 43 ). Complete release of the corpora from the pubic ramus has been described to further increase length, but is associated with significant risk to the neurovascular bundles of the penis, causing denervation and devascularisation of the penis ( 46 ).…”

Visualization of Penile Suspensory Ligamentous System Based on Visible Human Data Sets

“…In the plastic and reconstructive surgery field, the suspensory ligamentous system is clinically significant because of its relationships to the performance of penis-lengthening surgery. Although various penis-lengthening procedures have been developed to improve this surgery in recent years [ 4 – 6 ], the most widely used technique is the transversal incision of the fundiform ligament and partial division of the suspensory ligament from the pubic symphysis to allow forward movement of the root of the penis. This technique may enable the penis to extend outward to achieve the effect of elongation [ 7 , 8 ].…”

Non‐invasive and surgical penile enhancement interventions for aesthetic or therapeutic purposes: a systematic review

“…This review included a total of 57 studies assessing interventions for penile lengthening and/or enlargement in 1764 healthy men complaining of a small penis (18 studies) [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] and 2587 men with concomitant penile pathologies (39 studies) consisting mostly of PD and ED. Of the 57 studies included in the review, 25 assessed non-invasive interventions [13,[17][18][19][20][21][22][23][24][31][32][33][34][35][36][37][38][39][40][41][42][43][44]68,69] and 32 evaluated surgical procedures [14][15][16][25][26][27]…”