Wednesday, 17 July 2013

What is phalloplasty ?

Phalloplasty surgery is a very generic term used by doctors to refer to any surgical intervention performed for the modification (or reconstruction) of a penis or, occasionally, for the construction of an entirely new artificial penis (e.g. in people who have lost their penis due to accident).

One of these interventions is male enhancement (penis enlargement) surgery. Here in phalloplasty australia we only cover phalloplasties performed for penis enlargement purposes. As a quick note, a phalloplasty may also refer to surgeries performed to repair cosmetic damage following an injury, to treat peyronie’s disease and to create a new penis for female-to-male (FTM) transgenders.

Intended Results
There are two "basic" types of phalloplasty procedures that can either be performed alone or in combination. The first aims to increase the length of the penis while the second aims to increase its girth (circumference).

Reasons to have a phalloplasty
It should be noted that in most cases there is no medical urgency to have a phalloplasty exclusively for penis enlargement. The only exception to this rule is the micropenis condition, which many times has a devastating impact on the patient's mental and sexual life (depression, very low self-esteem, inability to have penetrative sex).   

Most men request to have penis enlargement surgery for one of the following reasons:
  • Some suffer from a feeling of inadequacy due to their small penis size (which often times is only in their head)
  • Some do understand their penis is average but simply want a bigger one
  • Some believe a bigger penis will boost their self-confidence
  • Some want a larger penis to enhance the pleasure of their partner
  •  Any combination of the above or other reasons

Phalloplasty Risks 
There are many things that can go wrong during any surgical operation, including phalloplasty. Some of the risks associated with phalloplasty are:
  • Post operative infections
  • Damage to surrounding tissue and nerves, leading to loss of sensitivity and perhaps partial or total erectile dysfunction
  • Excessive scarring resulting in a shorter or penis. Scarring may also lead to erections that point down, up, left or right.
  • Many times, patients are not satisfied by the results of phalloplasty. A study by the European Urology looked at 42 men who had procedures to lengthen their penis and found that only 35% of them were satisfied with the final outcome. 50 % of the unsatisfied ones took the surgical route again.
The general anaesthesia used prior to the actual operation also has some side effects of its own, including:
  • Feeling sick and/or vomiting after surgery (occurs in 33% of operated patients)
  • Shivering and feeling cold (25% of patients experience this symptom)
  • Confusion and memory loss, very common in elders and usually temporary
  • Fever 
  • Breathing difficulties
  • Dizziness
  • Bladder problems, some men report difficulty to urinate while some women "leak" urine.
  • Minor, temporary nerve damage. This affects about 1% of people and may cause numbness, tingling or pain. The problem usually resolves after a few days although it may take several weeks to heal completely
  • Heart or brain damage and death (exceptionally rare)

Approximate Costs of Phalloplasty
The price of the procedure varies, depending on which type of phalloplasty the patient chooses to have. For example, penile lengthening is cheaper compared to penile lengthening combined with penis thickening.

It is not uncommon for the final price to be different between patients receiving the same operation, as each case is unique and handled differently. In Australia, the price for a typical phalloplasty varies from 5.000 $ up to 20.000 $. Please note that there are many other factors influencing the overall cost of the procedure like the experience of the doctor  and the equipment used. Location is also crucial. Prices in Sydney may be completely different to prices in other areas like Melbourne or Perth. A last thing to remember, the saying "You get what you pay for" does hold some truth. The most expensive option is not always the best, but it is in your interest to be wary and cautious of inexpensive offers.

Very few - if any - insurance companies cover the cost of phalloplasty when it's performed strictly for penis enlargement and thus cosmetic purposes.

Non-surgical Alternatives
Using a certified penile stretcher is currently the only alternative non-surgical option for penis enlargement. Actually, many doctors ask their patients to use one after surgery to both reduce scarring and achieve even greater penile gains. See the phalloplasty alternatives section for more information on penile stretchers.

What happens during a typical phalloplasty surgery ?
The patient is first sedated using general anaesthesia. General anaesthesia  is a medically induced coma, during which the patient is essentially asleep, feeling no pain and having no awareness of what happens during the operation. Then, the surgical team starts the procedure the patient has opted for. Below is a brief description of the penis lengthening and the penis thickening procedure.

Description of penile lengthening procedure
Penile lengthening is achieved by loosening the ligament that suspends the penis inside the body. As a result, a part of the penis that resided inside the body is "ejected" on the outside. The penis is then fastened to its new position and when needed, skin flaps are placed at its base to elongate the penile skin. If all goes well, no complications will ensue and the "head" (glans) - will stay unaltered.

Please note that this technique results in a penis that although appears to be larger it actually isn't. Expect to gain a length increase ranging from 1 to 3 cm when erect and up to 25% + when flaccid.

There are some techniques that offer true penile lengthening. However, they are both extremely risky and expensive as they require an invasive deconstruction and reconstruction of the penis. This is why, they are typically reserved for patients with a micropenis or severe penis deformities. In short, what happens in such operations is that the whole penis is removed. Then a new penis is created using skin grafts and other materials. The new penis is placed where the old one was and the original penis is placed ontop the new one. The cost for having such a procedure is extremely high (more than 50.000$)/. Very few surgeons in the whole world are skilled enough to do such an operation.

Description of penile thickening procedure
To achieve penile thickening the surgeon first extracts fat - via a mini-liposuction - from the pubic area, abdomen, "love handles", or some other area of the body with plenty of fat. The fat is then purified and any blood and oils are removed before it's transplanted around the shaft. Some doctors prefer to use implants from other sources, for instance AlloDerm, which is material processed from donor skin.

This technique can result in an erect penis with a 20 to 40 % increase in girth.

surgeons doing a phalloplasty surgery for penis enhancement

Phalloplasty Recovery
You will either wake up in the operating room - after the surgery is finished - or in the recovery room with your pubic area bandaged. You should resist any urge to remove the bandages to see the results. Doing so will increase the chance of getting an infection by exposing the operated site.

Most patients report moderate pain following the operation, with varying levels from patient to patient, depending on the type of phalloplasty and the individuals' pain tolerance. Your doctor(s) will prescribe medication to manage the pain if needed.

Follow all the instructions given by your surgeon to the letter, including:
  • Do not have sex or masturbate (usually for a period of 4-6 weeks)
  • Do engage in any activities he has prohibited you
  • Take all the prescribed medication including painkillers, antibiotics etc

Failure to follow any of the above instructions may lead to several problems.

Please note that it will take several months for all the swelling to go away and up to a year for the scars to disappear.

Are the Results Permanent?
For penis lengthening, the results are usually permanent, although there are recorded cases in which the ligament has reattached and all gains were lost.

For girth thickening the results typically diminish over the course of time and disappear two to five years later. This happens because the fat is gradually absorbed by the body.

Do you really need a phalloplasty?
The truth is that most men don't really need penis enlargement surgery. According to the European standards for condom manufacturers, studies and other medical data, the average length of an adult erect penis ranges 12-15 cm. Chances are you fall within the normal rage.

Furthermore, the woman's vagina is like a tubular pathway made of muscles and is host to countless nerve endings. Not surprisingly, sexual pleasure is increased depending on the number of nerve endings that are stimulated by the penis. The more the nerve endings that are stimulated, the greater the stimulation. However, most receptors are located at the entrance of the vagina and respond to rhythmic movements, something achieved easily by an average sized penis. This is also why most women prefer girth to length. Only a few women will actually "benefit" from a really long penis and for many this is exclusively due to a psychological response! Therefore, an average penis is more than adequate for the majority of women.This is why the size of a penis should be only modified if it really qualifies as short or thin.

Unfortunately, penis enlargement operations are today carried on men who are actually average, but for whatever the reason is, want a bigger penis. Some falsely believe they are small and inadequate to satisfy a woman. Some had a previous bad experience by a woman who wanted something more. Some are actually above average (and know it) but still want to enlarge their penis! Whatever the reason, all these cases are operated primarily for aesthetic purposes. This is why such operations are usually not covered by insurance.

Having said that, a phalloplasty is not always an aesthetic procedure. In medicine, the term micropenis is used to describe a truly small penis, with an erect length of 7.5 cm or less. In these cases, achieving a normal sized penis with phalloplasty is difficult but not impossible.

micropenis case, 4 cm when erect
4 cm micropenis (erect)

Got any more questions? Leave a comment, phalloplasty-australia is here to answer them!

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