The girth of the penis refers to the circumference of the penis. Girth enhancement refers to a thickening of the girth of the penis, or an increase in penile circumference. In order to increase the girth of the penis, something must be added to it. A previous technique that used fat transfer (Free Fat Transfer) had many disadvantages, including lack of uniform fat distribution, secondary to uneven fat absorption; shrinkage, secondary to constant fat absorption and disappearance over time; and lumps, clumps and bumps on the shaft of the penis, secondary to fat sequestration and fat graft displacement during sexual activities. The best solution is a graft that can be attached in a flat position and stitched to the penile fascia to prevent it from moving during sexual activities.

Currently, there are two types of permanent graft available to increase the thickness (girth) of the penis. The first type of graft uses the patient’s own skin (dermal fat graft or DFG). Girth enhancement with dermal fat grafts (DFGs) requires peeling the epidermis from the harvested skin graft before placing it on the shaft of the penis. The second type of graft is AlloDerm®. (For more information about AlloDerm, see the AlloDerm section on this website.)

Girth enhancement surgery is performed under general anesthesia. The surgery requires two independent incisions: one at the base of the penis, and one on the neck of the penis, just below the corona. A graft is then placed in the appropriate area on the shaft of the penis. This area is usually the anterior three-fourths of the penile shaft.

Girth enhancement surgery can increase the circumference of the shaft of the penis 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. This maximum degree of enlargement is not possible for everyone, due to anatomical differences between individuals. The patient must have realistic expectations when undergoing this surgery.

Pain resulting from this surgery is minimal. Most men require one week off work, although it is possible to return to work three to four days after surgery. This varies, depending on the individual and on the demands of the job. Sexual activity must be avoided for at least six weeks, and there should be no participation in sports for at least four weeks.

It is important to note that many patients have unrealistic expectations of penile girth enhancement surgery. Despite what is written above, they think that after surgery their penis may increase two to three inches in circumference. This expectation is absolutely unrealistic and can create tremendous dissatisfaction for the patient. This dissatisfaction can, in turn, compromise the reputation of the surgeon and his techniques. The patient must have realistic expectations when undergoing this surgery.

Men have anatomical restrictions that prevent such large increases in penis girth. The main anatomical restriction to penis girth is the amount of space between the skin and the tunica albuginea that covers the cavernous bodies of the penis. Some men have enough space for three millimeters of graft(s); others have space for ten millimeters of graft(s). The surgeon works with the patient to help him to select a type and size of graft appropriate to his anatomical characteristics.

Penile girth enhancement is a safe surgical procedure that provides excellent results when performed by a qualified, trained surgeon. Dr. Alexander Krakovsky is Vice President of the American Academy of Phalloplasty Surgeons. In 2002, the American Academy of Phalloplasty Surgeons issued a position statement regarding phalloplasty surgeries. This statement outlined standards and guidelines for the safety of phalloplasty surgeries that use DFGs or AlloDerm. The statement specifies that phalloplasty surgeries are considered safe and effective under these standards and guidelines only if performed by a qualified surgeon who has completed special phalloplasty surgical training. Many plastic and cosmetic surgeons who have never undergone special phalloplasty training are performing penile enlargement surgeries. As a result, thousands of men are faced with injuries for which reconstruction is very difficult, or even impossible, to perform. Even when performed by a qualified surgeon, it is critically important that the patient learn about the possible complications of this type of surgery before making any decision regarding the surgery and, if the surgery is performed, the patient must precisely follow pre-operative and post-operative instructions.

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