Among the currently known methods for increasing the size of the penis, surgical correction is the most effective.Other methods either do not work (miracle ointments, poultices, dietary supplements) or have a short-term effect (vacuum pump - single use, injections - up to 12 months + possibility of side effects).A conservative method is a special device for lengthening the penis, an extender, which exposes the soft tissues of the corpus cavernosum and blood vessels to gradual stretching, but must be worn for a longer period of time (more than six months) without surgery.
Ligamentotomy of the penis is a relatively simple phalloplasty operation that allows the length of a normally functioning reproductive organ to be increased.
The surgical intervention consists of freeing the inner part of the penis shaft, hidden in the subcutaneous fat, by cutting the cartilaginous band that attaches it to the pubic bone.The restriction removed in this way allows the penis to be lengthened by 3-5 cm.After surgery, traction devices are used to prevent the ligament from fusing along the incision line with its previous position, but for a much shorter period of time than with conservative treatment.
The penile ligamentotomy enables lifelong changes in the physiological parameters of the penis.This has a positive effect on a man's psycho-emotional sphere and his sexual life.
It is estimated that a total of 15,414 ligamentotomy procedures have been performed worldwide, with almost one in five of these performed in Germany.
This operation is much simpler, safer and cheaper than penile prosthesis, however, if a man suffers from severe forms of erectile dysfunction in addition to the small size of the penis, it may be ineffective.
Indications
Ligamentotomy is performed only in adult patients and is justified in pathological cases for health reasons:
- congenital or acquired proliferation of the connective tissue of the penile ligament, which prevents the penis from straightening and makes erection painful (Peyronie's disease);
- replacement of the cells of the cavernous tissue of the penis with connective tissue cells (cavernous fibrosis);
- micropenis, when most of its stem is hidden in subcutaneous fatty tissue - the visible part of the erectile organ is small in size, which objectively complicates sexual life;
- penile injuries;
- Body dysmorphophobia is a man's obsessive dissatisfaction with the size of the penis (absolutely normal from an anatomical point of view) in the absence of more serious mental illnesses (if the length of the erect penis is 180 mm or more, the patient may be refused surgical correction).
Men who complain of a small penis despite being quite long usually suffer from penile dysmorphic disorder (BDD) or small penis anxiety (SPA).In both conditions, men consistently underestimate their penis size and overestimate the average size of other men.
The indication for plastic surgery to increase the length of the male genital organ may be the patient's desire arising from aesthetic considerations (in the absence of contraindications), for example, the apparent length of the erect penis is less than 120 mm.
Preparation
The preparatory process begins with a consultation with a urologist, who examines the patient, finds out the reasons for which he had to resort to surgical correction, and makes sure that he does not have any diseases of the urinary tract.As part of the preoperative examination, the patient undergoes a blood test: clinical, glucose, biochemical composition, blood coagulation, blood group and Rh factor, presence of syphilis, hepatitis B and C, HIV infection.First, you will undergo fluorography and electrocardiography.
The list of pre-operative examinations can be expanded based on the presence of chronic diseases of the patient.
The patient talks to the anesthesiologist, who is warned that since the operation is performed under anesthesia, in order to avoid suffocation with vomit, he should not eat or drink for the next eight hours.
You should shave your pubic hair the night before surgery.
Ligamentotomy technique
The actual surgical procedure consists of cutting the superficial cartilaginous ligament that holds the penis in a certain position.This manipulation allows the penis to be pulled out from under the uterus without violating its anatomical integrity.
The operation is performed openly, through an incision, often made in the scrotal area (in the midline) or in the lower part of the pubis, when the greatest release of the hidden part of the shaft of the penis is required.Usually, the approach is discussed before surgery and determined depending on the problem to be solved.
Modern operating theaters are often equipped with endoscopic equipment, in which case microincisions are made.
The classic method consists of cutting the tape and stretching the penis to a certain 25-50 mm (depending on the length of the hidden part of the shaft).Suturing and fixing the elongated organ using a stretcher.
A more modern method is to use the patient's fat, which is taken from the places that accumulate during surgery.Fat is placed in the cavity of the excised ligament (lipofilling), which promotes tissue healing and prevents adhesions.A suture is then applied.The second type of intervention takes a little longer.
Complete release of the corpora cavernosa from the pubic ramus carries a significant risk of severing the neurovascular bundles of the penis, causing penile denervation and devascularization.
The operation itself takes about 30-60 minutes, the patient stays in the office for a day, however, its success is facilitated by proper post-operative care, which is the second and necessary stage of penis enlargement.
Contraindications to implementation
The possibility of performing the surgery is not considered until the patient turns 18.
He must not have mental illness, bleeding tendency, urinary tract disease, malignancy or diabetes.
The operation is not performed during the exacerbation of the patient's acute infectious diseases and/or chronic diseases.
Consequences after the procedure
After ligamentotomy, the functions of the genital organ (urination and erection) are usually completely preserved;the muscle tissues, ligaments and blood vessels responsible for these functions are not affected by the surgery.During ligamentotomy, the lymphatic drainage should not be disturbed, as the lymphatic vessels cannot be damaged if the operation is performed properly.However, slight swelling and bruising may occur in the surgical area.Access through the scrotum is easier to tolerate, the suture heals faster, but hymenectomy is more often complicated by hemorrhage and swelling.
Drowsiness and incoordination resulting from general anesthesia usually disappear within 24 hours, even in the most sensitive patients.
Complications after the procedure
Paradoxically, the main side effects of this procedure are prolapse, shortening of the penis and lack of penile support during erection, leading to difficulty in intercourse and penetration.
Complications after the procedure are certainly possible.Still, it's an operation.If unwanted consequences occur, consult your doctor about taking the necessary measures.
Closure of sutures after ligamentotomy is a normal process.The resulting scar is always dense;it will soften later.The stitches heal in about three weeks.For some earlier, for others later.
Proliferation of sutures indicates a bacterial infection, and it is not at all necessary that "an infection occurred during the operation".It is possible that the patient had a chronic infectious process.The infection is usually treated with antibacterial drugs.You need to consult a doctor for a prescription.
Plaques should not appear after ligamentotomy.The substances that cause the curvature and pain of the penis are surgically removed during the operation.It is a proliferation of fibrous tissue in the tunica albuginea of the corpora cavernosa.The main reason for their appearance is microtrauma of the penis (usually during sexual contact), with the development of microbleeds, in the place of which connective tissue areas are formed.If the plaques appear again, first of all you should consult a doctor, and secondly, you should discuss with your doctor what is causing their appearance.
A scar may also appear after a ligamentotomy, as postoperative scars are created during any operation.Over time, they become softer and separate.Much depends on the quality of the patient's skin and the skill of the surgeon.Physiotherapy and other methods are used to dissolve postoperative scars.If the scar bothers you a lot, see a doctor.
Post-procedure care
In the postoperative period, pain relievers may be prescribed to relieve pain.Bandages are applied every 2-3 days, sutures are usually removed 14 days after surgery.It is recommended to avoid sexual contact for 1-1.5 months.
The mandatory post-operative stage of all types of surgery is to first wear a stretcher (for the first three weeks, sometimes longer) and then an extension;without this, surgery may be pointless as the ligament heals along the tear and the penis returns to its original position.In addition, stretching the genital organ allows you to lengthen it by an additional 15-25 mm.
The minimum period of wearing the extension is two months.It is worn only for one to two hours on the postoperative days, then for six to eight hours every day.Be sure to take it off at night.
The ligament heals under the action of the stretcher, but not along the cut line, but in a stretched position.The presence of the patient's own fat in the incision cavity promotes rapid tissue granulation.
You should gradually and carefully stretch the penis, avoiding pain, strictly following the doctor's recommendations.Only a slight tension should be felt.
Reviews
Opinions about the operation differ.Some complain of complications, hematoma and fever.Basically, such complaints are typical in the early postoperative period and a doctor should be consulted.Every body is unique and stitches need at least 10-14 days to heal.
The results of ligamentotomy were not always favorable.Patient and partner satisfaction levels range from 30 to 65%.The operation increases the resting length of the penis by an average of 1-3 cm.The low satisfaction rate makes this surgical technique unfavorable for many patients.
In addition, the question is often asked whether it is possible to lengthen and increase the thickness of the penis at the same time.This is not recommended.Experts recommend ligamentotomy first, and only after stopping all measures to extend the length of the penis, with the help of an extender that tightly fixes the organ, which is unacceptable after increasing the thickness of the penis, you can proceed to the next stage.