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Many of us are often afraid to talk about so called “embarrassing areas”; hence why one of the least talked about areas of cosmetic surgery is that available for the male genitalia or penis.
Modern society has become obsessed with the “size matters” argument, leading some men to feel that their penis size is somewhat inadequate, especially in a communal situation of undress such as gym changing room showers or when with a sexual partner; hence tempting them to seek ways of increasing both penile length and girth (width). Due to this preoccupation with penis size, many non-surgical methods are now touted as remedies, with everything from pills to pumps and massage techniques offered as a means of enhancing the penis; but the only really successful way of altering the size and shape of a penis is through surgical procedures.
Based on various studies carried out over the years, it is generally agreed that the average human male penis is 8.5 – 10.5 cm (2.5 - 4 inches) long when flaccid, and 12.5 – 16.5 cm (5 – 6.5 inches) in length, with an average circumference of 11.5 – 12.5 cm (4.5 - 5 inches) when in a fully erect state. Studies have tended to be on Caucasian men so variations based on ethnic group are not noted.
Very few men actually have a very small penis, known in medical terms as a micropenis, where a stretched flaccid penis is less than 4cm (1.5inches) in length or 7cm (2.5 inches) when erect. This is a very unusual condition which is normally diagnosed and treated in childhood with testosterone hormones.
Despite being reduced in size, a penis smaller than the average will still function as normal and problems are only noted, often leading to a lack of self confidence, when with a sexual partner and vaginal penetration is attempted.
Should a man still be concerned about the length or girth of his penis, there are now a range of surgical options available which can address and hopefully resolve these problems.
If you are considering penile augmentation surgery; the following information will give you a basic understanding of the procedures. It can't answer all your questions, since a lot depends on the individual patient. Please ask a practitioner about anything you don't understand.
Types of Surgery
The main type of penile augmentation surgery available in the UK is called a penoplasty operation and includes penis enlargement and/or lengthening, where the augmentation is either in the length of the penis, achieved by cutting the ligaments which attach it to the body to allow it to drop down further, or in the girth or width of the penis, with the use of fat transfer techniques. Often to create a more natural look, both lengthening and augmenting the girth will be performed at the same time, although one or the other can be performed as a single operation.
Your first discussion with a surgeon should clearly set out your expectations and whether the operation can give you the results you desire.
Careful discussions regarding the reasons for wanting penile surgery and your suitability for this type of surgery are very important at this stage. Make sure that you obtain as much information as is necessary to enable you to make a fully informed choice and make sure you receive satisfactory answers to all your questions.
A medical history should also be taken to make sure that there are no reasons why you shouldn’t have this operation. You would normally be asked to sign a consent form which means that you have understood the potential benefits and risks associated with penile surgery.
Photographs will also be taken by the practitioner as a "before and after" comparison at a later date.
The surgeon may also wish to write to your G.P. giving details of the operation so that if there are any problems associated with surgery in the short or long-term your doctor is aware of the procedure and can help you to recover.
Penile surgery is usually performed under local anaesthetic with IV sedation, meaning that you are conscious but in a reduced state of awareness and will feel no pain, but it can also be carried out under a general anaesthetic.
Please take into account that a general anaesthetic carries more potential risks – this should be clearly explained by the surgeon before you make any decisions about the anaesthetic. Types of anaesthesia available should always be discussed with your surgeon.
If you make a decision to go ahead with penile surgery, the actual procedure may take place in an outpatient surgical clinic where you can go home the same day.
The penoplasty operation(s) usually takes about 1 – 2 hours, depending on whether you have the lengthening or enlargement procedures on their own or both.
The genital area will also require shaving prior to any of the procedures.
It may be necessary to have a circumcision performed at the same time as the lengthening and/or enlargement procedures, as this avoids swelling of the foreskin, which can last for several weeks.
In a lengthening procedure a small incision is made above the base of the penis, and the ligament which suspends it, running from the pubic bone to the top of the penis is cut. This causes the penis to drop forward, thereby lengthening its appearance from the outside by 1 – 2 inches (20 – 50%), although the actual gain will depend from person to person. The ligament is then reattached lower down and a flap of skin, taken from the pubic bone area, is used to cover the new extension, created from bringing the “inner” penis forward. Often dissolvable stitches are used, both internally and on the external cuts, but some surgeons do use normal stitches as well, which will need to be removed after a couple of weeks.
This lengthening operation only affects the non-erect (flaccid) length of the penis, any post-operative erection will remain the same size but the angle of it may be slightly lower than it was prior to surgery.
To enlarge or increase the girth of the penis, a small liposuction procedure is required first to obtain fat from the abdomen or thighs which can be transferred to the penis by injection. As the fat is injected into the penis, it avoids incision scars and reduces the recovery time required.
The penis can usually be increased in girth or circumference by 1 – 2 inches (30 – 50%). The enlargement will be visible in both flaccid and erect states.
With the enlargement procedure there is a risk that the body will reabsorb some of the fat injected into the penis, in fact as much as 30% of the injected fat can be reabsorbed in the first few months. For this reason, surgeons will overfill a little at the point of transfer so that the shaft is just slightly wider than the tip.
If required, top-up fat procedures can be carried out after 6 months. Final results can be long lasting.
You will normally be recommended to rest and recover for a week following the operation, before returning to work.
Exercise should be avoided for 3 – 4 weeks and sexual activity can normally be resumed in a month, although full results of the lengthening procedure may not be achieved by this point and can take 3 – 6 months.
Post-recovery the functioning of the penis will be completely normal, both in terms of urination and erection ability.
Side Effects and Risks
Like all surgical procedures, there is always a possibility of complications or side effects and, although rare, these can include bleeding, infection, a reaction to the anaesthesia, blood or fluid collection underneath the skin (haematoma), nerve damage, and an irregular or a “lop-sided” appearance to the penis after the operation, most notably with the enlargement procedure where lumps may occur due to the position of the fat; massaging of the shaft can resolve this.
In general sexual performance is not known to be effected by surgery.
Following penoplasty you should expect some pain and discomfort for a few days which can be treated with over-the-counter or prescribed pain relief tablets. There will normally be some swelling, numbness and bruising to the area which should fade after a couple of weeks.
With lengthening procedures you can expect a small, permanent scar in the area at the base of the penis, although this is often masked by the pubic hair once it regrows.
It is also important to have realistic expectations of what penoplasty can achieve to avoid disappointment with the results.
It is very important that you follow the advice of your surgeon carefully after penile surgery.
Post-surgery advice may include:
Who Can Do It
Only fully trained and qualified surgeons should perform penile surgery.
For more information about practitioner training, qualifications and relevant medical organisations please view the information contained within the Legislation section of the Consulting Room.
You will not be able to access these types of treatment via the National Health Service (NHS).
We would always recommend that you visit your General Practitioner before embarking upon a major procedure. As well as their advice and guidance they may also be able to refer you to a local NHS Hospital who can treat you in certain circumstances.
The NHS has set out the following guidelines on how to get cosmetic surgery through the NHS:
"To qualify for surgery on the NHS you must meet specific criteria as set out by your local health authority. The NHS will not pay for surgery for cosmetic reasons alone. Reconstructive and cosmetic surgery to correct, or improve, congenital abnormalities and injuries will usually be carried out free of charge.
NHS reconstructive surgery is performed by plastic surgeons who have had extensive training and belong to the British Association of Plastic Reconstructive and Aesthetic Surgeons. Surgeons who carry out cosmetic surgery through the NHS also belong to the British Association of Aesthetic Plastic Surgeons.
To receive cosmetic surgery from the NHS, you will normally need a referral from your GP. You will have a consultation with a plastic surgeon and an assessment by a psychiatrist, or psychologist. It will then be decided whether there is enough social, psychological, or physical benefit to be gained to justify surgery."
Private costs for penile surgery range from £3,500 - £5,000 for lengthening procedures and £1,000 - £2,500 for enlargement procedures. The price for both procedures to be performed at the same time is often cheaper than the combined overall prices and is around the £5,000 mark.
Although some men may feel insecure about the size of their penis, leading to low self-esteem and feeling of sexual inadequacy, the decision to have penile surgery is not one to be taken lightly.
There are also many pills, potions and devices touted on the Internet and in emails which promise to enhance what nature gave you, but which sadly have no clinical evidence to back them up or which only provide temporary results. In fact the only sure way of increasing the size of the penis is with surgery.
Due to the psychological implications of such surgery, some surgeons will insist that men considering such procedures visit a counsellor beforehand to discuss their particular anxieties and circumstances. In some cases, the appearance of a larger penis can simply be achieved by weight loss or shaving the hair at the base of the penis to create an optical illusion of sorts.
If all avenues have been explored and surgery is still considered the only option, then both lengthening and enlargement, or girth widening procedures are available in the UK.
Before and After Pictures
Results vary enormously depending upon both the patient and the skill of the individual surgeon, so outcomes for cosmetic surgery procedures will always be more variable than those for less invasive non-surgical treatments.
We currently do not have any before and after images for Penile Augmentation surgery.