Phalloplasty Surgery Questions and Answers
Does my current satisfaction level with my penis size and appearance make me a candidate for phalloplasty surgery?
- Q. Do you like the size of your penis?
A. If your answer is no, you are a candidate for phalloplasty surgery.
- Q. Do you think your penis is too small in the flaccid (soft) state?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you think your penis is too small in the erect (hard) state?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you wish your penis to be longer and thicker?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Would you change the size of your penis, if you could?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you think that you are less of a man because of the size of your penis?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you feel ashamed of the size of your penis?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Are you preoccupied with a feeling of guilt about the size of your penis?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you avoid wearing clothes, or participating in activities, that will allow others to see the size of your penis?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you find it difficult to enjoy sex because you are self-conscious about the size of your penis?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you avoid sex because of the size of your penis?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
- Q. Do you like looking at your penis in the mirror?
A. If your answer is no, you are a candidate for phalloplasty surgery.
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Q. Do you think that other people might perceive your penis as unattractive?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
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Q. Do you think that other people might perceive your penis as inadequate?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
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Q. Do you think that enhancing your penis would give you added self-confidence?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
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Q. Do you think that penile enlargement surgery would improve your self-esteem and the quality of your life?
A. If your answer is yes, you are a candidate for phalloplasty surgery.
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Q. How much can a man’s perception of the size of his penis affect his sexual relationships?
A. A man’s perception of the size of his penis is one of the most critical issues in sexual relationships, even when his penis is in the normal size range.
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Q. Are a man’s self-esteem and self-confidence affected by the size of his penis?
A. Yes.
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Q. Does a man’s self-esteem and self-confidence change after phalloplasty surgery?
A. Yes.
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Q. Can phalloplasty surgery improve self-esteem, self-confidence, and quality of life?
A. Yes.
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Q. How does phalloplasty surgery improve self-esteem and quality of life?
A. When a man has experienced feelings of penile inadequacy, even with a normal penis size, the results of phalloplasty surgery frequently foster an improved sexual self-image that positively affects self-respect and intimate relationships.
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Q. Because phalloplasty surgery can improve self-esteem and quality of life, and because the risks of current phalloplasty surgical techniques are low (similar to other cosmetic/plastic surgery), is penile enlargement surgery worth considering as elective surgery?
A. Yes.
How much can phalloplasty surgery increase penis size?
- Q. How much can penile length be increased with lengthening phalloplasty surgery?
A. Achievable length varies. This can not be predicted before surgery. On average, lengthening phalloplasty surgery, followed by an additional year of physiotherapy stretching exercises, increases penile length one-half to one-and-one-half inches in the flaccid position.
- Q. How realistic is a desire to increase the length of the penis three to four inches with phalloplasty surgery or with any other available method?
A. This is not at all realistic.
- Q. Does the success of lengthening phalloplasty surgery depend on the surgery or on post-surgical stretching exercises?
A. Both. The desired results are achieved through a combination of surgery, performed by the surgeon, and a post-surgical stretching exercise therapy program, performed by the patient.
- Q. How much can girth be increased with Girth Enhancement?
A. Shaft circumference enlargement depends largely on the quantity of implanted skin. This enlargement may vary from a 10% increase to a 30% increase over the existing pre-operative circumference size depending on the number and size of the grafts used during this surgery.
- Q. How much glanular enhancement can be achieved with Standard and Maximum Glanular Enhancement?
A. Glanular enhancement also depends on the quantity of implanted skin. This enhancement may vary up to a 15% increase over the existing pre-operative circumference size depending on the number and size of the grafts used during this surgery.
Can the surgeries that increase penis length and circumference be performed sequentially? Can they be combined?
- Q. Can lengthening and thickening (girth enhancement) phalloplasty surgeries be performed at different times?
A. Yes.
- Q. Can lengthening and thickening (girth enhancement) phalloplasty surgeries be performed at the same time?
A. Yes.
- Q. Can lengthening, thickening, and glanular enhancement surgeries be performed at the same time?
A. Yes.
Can you give me more information about the phalloplasty surgery process?
- Q. Is an HIV positive patient a candidate for phalloplasty surgery?
A. No. A healthy immune system is a necessary component of appropriate post-surgical healing. An immune system impaired by HIV would compromise the healing process and promote the development of post surgical infection complications.
- Q. Can a patient continue to smoke if he is scheduled for phalloplasty surgery?
A. Not at all. Smoking has a tremendous effect on the healing process and must be discontinued from at least two months prior to surgery to two months after surgery. Phalloplasty surgery is not performed on patients who smoke during the two months prior to surgery.
- Q. How long does a patient need to remain near the surgical facility before and after surgery?
A. One day before surgery and one day after surgery.
- Q. What kind of anesthesia is usually used for phalloplasty surgery?
A. General anesthesia.
- Q. How much pain does a patient experience after phalloplasty surgery?
A. The pain is minor. In the majority of cases, patients experience discomfort, rather than pain. If a patient has a low tolerance for pain, additional post-surgical pain medication can be prescribed.
- Q. How quickly after surgery does the patient see the results of the surgery?
A. Following a girth enhancement procedure with DFGs or AlloDerm (R), the results of the surgery can be seen immediately. Following a lengthening enhancement procedure, the results of the surgery can be seen after one year of regular physiotherapy exercises. (For more information about AlloDerm, see the AlloDerm section on this website.)
- Q. Will insurance cover phalloplasty surgical procedures?
A. No.
What are some of the post-surgical requirements for phalloplasty surgery?
- Q. How long after surgery must the patient avoid sexual activitiy?
A. The patient can not engage in any type of sexual activity, including masturbation, for at least three weeks after lengthening surgery, or for six weeks after combination augmentation (Penile Dual AugmentationTM or Penile Triple AugmentationTM), girth augmentation, or glans augmentation. After reconstruction surgery, this period of waiting is eight weeks or more. Usually, after these time periods, the patient can resume his normal sexual activities, but he must use a condom during the first month of these sexual activities. Before resuming sexual activity, clearance by the surgeon is required for the purposes of safety.
- Q. For how long after surgery must the patient prevent an erection and why?
A. Erections are considered sexual activity. The patient must prevent spontaneous erections during the same time periods as those listed above for avoiding sexual activity after surgery. These time periods allow the surgical wounds to heal.
- Q. How are spontaneous erections prevented?
A. There are several medications available to prevent post-surgical erections. The patient must stay in very close contact with the surgeon to monitor and suppress spontaneous erection.
- Q. How critical is it to have an erection after surgery?
A. Very critical. An erection tears off the skin, opens the wound, and dramatically increases the post-surgical infection rate.
- Q. How long after lengthening surgery does the patient begin a physiotherapy program?
A. The patient must begin the hand stretching technique one week after single augmentation (lengthening) surgery. After performing hand stretching for two weeks, the patient must begin a physiotherapy program, using a penis stretching device, for up to two hours a day, five days a week, for up to one year after surgery.
If the patient has undergone penile lengthening as part of a multi-augmentation surgery, the patient must begin the hand stretching technique four to six weeks after surgery, depending on the speed of healing. After performing hand stretching for two weeks, the patient must begin a physiotherapy program, using a penis stretching device, for up to two hours a day, five days a week, for up to one year after surgery.
If the patient has undergone reconstruction surgery, time frames are defined by the surgeon.
- Q. Is physiotherapy necessary to achieve an optimum result after lengthening phalloplasty surgery?
A. Yes.
Who is qualified to perform phalloplasty surgery?
- Q. Is phalloplasty surgery usually performed by a urologist or a plastic surgeon?
A. Phalloplasty surgery can be performed by a urologist, a plastic/cosmetic surgeon, or a general surgeon trained to perform phalloplasty surgery.
- Q. What kind of training does a phalloplasty surgeon usually have?
A. There is no formal phalloplasty surgery training available in the United States at this time. The American Academy of Phalloplasty Surgeons has developed guidelines and standards that a phalloplasty surgeon must follow.
What are the level of risk and the satisfaction rate of phalloplasty surgery?
- Q. What is the satisfaction rate of phalloplasty surgery?
A. The level of satisfaction with phalloplasty surgery depends in large part on the patient’s expectations of the surgery. The patient must have realistic expectations regarding the surgery, and understand that desirable and achievable results are not always the same. In a recent follow-up study of 311 patients who underwent phalloplasty surgery using AlloDerm (R), a questionnaire explored satisfaction in the areas of penis size, sexual experiences, and self-perception of the penis before and after enhancement surgery. Seventy-four per cent of these patients reported the highest level of satisfaction with their male cosmetic genital surgery. (For more information about AlloDerm, see the AlloDerm section on this website.)
What are the potential post-surgical complications of phalloplasty surgery?
- Q. How often does post-surgical retraction develop?
A. Not very often. Usually, post-surgical retraction develops in patients who are prone to keloid scar formation. A keloid scar is a linear mass of hyperplastic scar tissue. It develops in the dermis and adjacent subcutaneous tissue, usually after trauma or surgery in genetically predisposed individuals.
- Q. Are there other post-surgical complications the patient should know about?
A. Bruising, swelling, temporary changes in skin sensation during the healing period (not related to sexual sensation), and infection (2% to 3% in the phalloplasty surgery field today) are other possible post-surgical complications. Also, the erection angle may decrease after the lengthening procedure. Some patients have developed fibrosis of superficial veins, bleeding, keloid scar formation, skin incision separation, and erectile dysfunction.
What can you tell me about fat injections, AlloDerm (R), dermal fat grafts (DFGs), supracavernosal and pericavernosal techniques, “penis enlargement pills,” and stretching and pumping devices?
- Q. Do you recommend fat injections to increase the size of the penis?
A. No.
- Q. Do you recommend phalloplasty surgery with AlloDerm (R)?
A. Yes.
- Q. Do you recommend phalloplasty surgery with dermal fat grafts (DFGs)?
A. Yes.
- Q. How does the use of AlloDerm or dermal fat grafts (DFGs) for phalloplasty surgery compare with the use of fat injection for the same surgery?
A. A fat injection is an injection of “free fat” that is not attached to anything. It can move around under the skin and cause lumpiness and unevenness. It can also leave the area where it is injected, and therefore needs to be injected again from time to time.
A dermal fat graft (DFG) is a graft of the patient’s own skin with the attached fat. This means that the fat is “anchored,” and cannot move, once it has been positioned. AlloDerm and DFGs can be positioned uniformly and do not require maintenance. These two types of grafts are permanent. (For more information about AlloDerm, see the AlloDerm section on this website.)
- Q. What is the difference between supracavernosal and pericavernosal penile widening techniques?
A. Supracavernosal penile augmentation is a cosmetic surgery procedure that increases the circumference of the penis in the flaccid state. Pericavernosal penile augmentation is a surgical procedure that increases the size of the penis in both the flaccid and the erectile states. I do not offer pericavernosal penile widening.
- Q. Do you offer penile augmentation surgery with fat injection, AlloDerm, or both?
A. I do not offer penile augmentation with fat injection. I offer only penile augmentation with permanent grafts (either AlloDerm or DFGs).
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Q. How much penis enlargement can be achieved using pills?
A. None.
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Q. Are these pills harmful or harmless?
A. Many existing “penile enlargement pills” are very harmful, and none of them should be taken without consulting a physician.
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Q. Do stretching devices permanently increase the size of the penis?
A. No. Used without surgery, these devices provide only a temporary increase in the length of the penis, for as long as they are used. Although a stretching device is used for up to one year following permanent penile lengthening surgery, no additional stretching is needed once the stretching program has been completed.
- Q. Does use of a pumping device following a girth enhancement procedure provide any significant benefits?
A. No.
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