Penis Enlargement:
- penis lengthening (length surgery),
- penis widening (girth surgery),
- inflatable implants

Penis Lengthening (length surgery)

Approximately one-third to one-half of the penis is inside the body, and is internally attached to the undersurface of the pubic bone. Penis lengthening involves the release of the fundiform ligament and the suspensory ligament that attaches the two erectile bodies to the pubic bone (ligamentolysis). The suspensory ligament makes the penis arch under the pubic bone. Release of this ligament allows the penis to protrude on a straighter path, further outward to give more functional length. With the penis on stretch, the ligament is divided close to the pubic bone until all midline attachments have been freed. Once these ligaments have been cut, part of the penile shaft (usually held within the body) drops forward and extends out, enlarging the penis by 20-30 mm (0.78-1.18 in.). After surgery, part of the postoperative treatment includes stretching of the penis to prevent the severed suspensory ligament from healing shorter than it was previously. The article "Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results" discussed the subject. According to Nim Christopher, a urologist at St. Peter's Andrology Center in London, among men who have had the surgery, "the dissatisfaction rate was in excess of 70 percent".

Real penile lengthening (i.e.; lengthening of corporal bodies vs. ligamentolysis) is not a routine and safe procedure because of high risk of losing the ability to have an erection. It can be done safely only in patients with erectile dysfunction or Mb Peyronies concomitantly with implantation of penile prosthesis. The world's leading urologists specializing in the field of penis enlargement surgery use only ligamentolysis, liposuction of the pubic area, and skin redistribution. They state clearly that surgeons can only expose the penis more outside the body with especially visible results in obese patients and ones with different deformities of penile skin where the penis is covered.

Penis Widening (girth surgery)

A related method involves injection of silicone, PMMA[2] and other materials into the penis and scrotum, to achieve girth enlargement. The results of the study into penile augmentation surgery mentioned above confirm that surgical techniques used to thicken the penis are far more effective than those designed to increase penile length. In the research sample of men studied, flaccid circumference following the above procedure had increased from an average of 3.1 inches to an average of 4.1 inches, whilst erect penile circumference increased from an average of 4.1 inches before surgery to 4.8 inches after surgery., but is effectively irreversible and may have side effects including loss of sensation, inability to perform penetrative intercourse, scarring and deformation.

Injections of other substances, including collagen, mineral oil, and even KY Jelly may have similar effects, but also may cause extreme scarring and permanent disfigurement. These may include a bump, permanent or temporary, on the stem of the penis itself, which would actually be the collected collagen or silicone introduced in the erectile tissues. This forms an unsightly lump around the base of the penis where it settles down and may inhibit the flow of the blood itself. Other effects may be the slight decrease of the glans width as compared to the overall stem of the penis.

In 2006 the journal of European Urology reported autologous tissue engineering using biodegradable scaffolds as beneficial not only for men with penile dysmorphic disorder and for correcting severe penile shaft deformity after lipofilliing but also an advanced, well-proven therapeutic approach for penile girth enhancement with remarkable safety, reproducibility, superior cosmetic results, low morbidity and low incidence of post-operative complications. Unlike the high level of disatisfaction with lengthening cited in the opening paragraph of this article, 81% of patients scored the results of autologous tissue engineering as "excellent" and "very good" with most experiencing a 4 cm (1.6 inches) permanent flaccid girth gain. Unlike the injection or implantation of foreign substances into the penis such as AlloDerm®, silicone, and other substances, tissue culture leaves no residual foreign tissue around the penis after scaffold reabsorption by the body.

Although AlloDerm® (treated cadaver flesh) is currently being used by some plastic surgeons, its manufacturer does not recommend it for penis enlargement phalloplasty. The USA Food and Drug Administration (FDA) regulates its use and has specifically not approved AlloDerm® as a “void filler” nor for “cosmetic augmentation”. The manufacturer warns phalloplasty surgeons that it is: “important to clarify ... cosmetic augmentation phalloplasty does not fall within approved procedures for which LifeCell can promote AlloDerm®”. The articles Penis enlargement Surgery: Myths and Facts and Penile Suspensory Ligament Division for Penile Augmentation: Indications and Results do a good revision about the subject .

Inflatable Implants

A further method is to replace the two corpora cavernosa with inflatable penile implants. This is performed primarily as a therapeutic surgery for men suffering from complete impotence; an implanted pump in the groin or scrotum can be manipulated by hand to fill these cylinders from an implanted reservoir in order to achieve an erection. The replacement cylinders are normally sized to be direct replacements for the corpus cavernosa, but larger ones can be implanted.

One advantage to this surgery is that an erection can be created whenever desired, for as long as is desired and as firm as desired. The major negative to it is that this surgical procedure can never be reversed.