The most effective among all currently known methods of increasing the size of the penis is its surgical correction.Other methods either do not work (miracle ointments, compresses, dietary supplements) or give a short-term effect (vacuum pump - one-time use, injections - up to 12 months + the possibility of side effects).A conservative method is to use 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 it must be worn without surgery for a long period of time (more than six months).
Ligamentotomy of the penis is a relatively simple phalloplastic operation that allows you to increase the length of a normally functioning reproductive organ.
Surgical intervention consists of releasing the internal part of the penis shaft, hidden in the subcutaneous fat, by cutting the cartilage-like ligament that fixes it to the pubic bone.The restriction removed in this way makes it possible to lengthen the genital organ by 3-5 cm. After surgery, in order to prevent the ligament from fusing along the incision line to its previous position, traction devices are used, but for a much shorter period of time than with conservative treatment.
Penile ligamentotomy allows you to change the physiological parameters of the penis for life.This has a positive effect on the psycho-emotional sphere of a man and his sex life.
It is estimated that a total of 15,414 ligamentotomy procedures have been performed worldwide, with almost one in five of all procedures performed in Germany.
This operation is much simpler, safer and cheaper than penile prosthesis, however, when a man, in addition to the small size of the penis, also suffers from severe forms of erectile dysfunction, it may be ineffective.
Indications
Ligamentotomy is performed only on patients who have reached the age of majority, and can be indicated for health reasons in pathological cases:
- congenital or acquired proliferation of connective tissue of the penile ligament, which prevents the erect penis from straightening and makes erection painful (Peyronie's disease);
- replacement of cells of the cavernous tissue of the penis body with connective tissue cells (cavernous fibrosis);
- micropenis, when most of its shaft is hidden in the subcutaneous fatty tissue - the visible part of the erect 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 (quite 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 denied surgical correction).
Men who complain of a small penis despite being of sufficient length usually suffer from either penile dysmorphic disorder (BDD) or small penis anxiety (SPA).In both of these disorders, men consistently underestimate the size of their penis and overestimate the average size for other men.
An indication for plastic surgery to increase the length of the male genital organ may be the patient’s desire, caused by his 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 will examine the patient, find out the reasons that prompted him to resort to surgical correction, and make sure that he does not have diseases of the genitourinary organs.As part of the preoperative examination, the patient undergoes blood tests: clinical, glucose, biochemical composition, coagulation, blood group and Rh factor, the presence of syphilis, hepatitis B and C, HIV infection.He will first undergo fluorography and electrocardiography.
The list of studies before surgery can be expanded based on the presence of chronic diseases in the patient.
The patient will talk with the anesthesiologist, he will be warned that since the operation is performed under anesthesia, in order to avoid asphyxia by vomit, he should not eat or drink for the next eight hours.
On the eve of the operation, you need to shave your pubic hair.
Ligamentotomy technique
The actual surgical intervention consists of cutting the superficial cartilaginous ligament that holds the penis in a certain position.This manipulation allows you to pull the penis out from under the womb without violating its anatomical integrity.
The operation is performed openly through an incision, which is often made in the scrotum area (in the midline) or in the lower part of the pubis, when the greatest release of the hidden part of the penis shaft is required.Typically, the approach is discussed before surgery and is determined depending on the solution to the problem.
Modern operating rooms are often equipped with endoscopic equipment, in which case micro-incisions are made.
The classic method consists of cutting the ligament and stretching the penis to a certain length up to 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 involves using the patient’s fat, which is taken from the places where it accumulates during surgery.Fat is placed into the cavity of the dissected ligament (lipofilling), which promotes tissue healing and prevents adhesions.After which a suture is applied.The second type of intervention takes slightly longer.
Complete release of the corpora cavernosa from the pubic ramus is associated with a significant risk of disruption of the neurovascular bundles of the penis, causing denervation and devascularization of the penis.
The operation itself lasts about 30-60 minutes, the patient stays in the clinic for a day, however, its success is facilitated by proper postoperative care, which is the second and necessary stage of penis lengthening.
Contraindications for carrying out
The possibility of performing the operation is not considered until the patient turns 18 years old.
He should not have mental illnesses, a tendency to bleed, genitourinary diseases, malignant tumors or diabetes.
The operation is not performed during periods of acute infectious diseases in the patient and/or exacerbation of chronic ones.
Consequences after the procedure
After ligamentotomy, the functions of the genital organ (urination and erection) are usually completely preserved; the muscle tissue, ligaments and vessels responsible for these functions are not affected during the operation.Lymphatic drainage during ligamentotomy should not be disturbed, since the lymphatic vessels should not be damaged if the operation is performed correctly.However, slight swelling in the surgical area is possible, as are bruises.Access through the scrotum is easier to tolerate, the suture heals faster, but the incision on the pubis is more often complicated by hematomas and swelling.
The result of using general anesthesia is drowsiness and impaired coordination of attention usually disappears within 24 hours, even in the most sensitive patients.
Complications after the procedure
Paradoxically, the main side effects of this procedure are relapse, shortening of the penis and lack of support for the penis during erection, leading to difficulty in intercourse and penetration.
Complications after the procedure are certainly possible.Still, this is an operation.If undesirable consequences occur, you should consult a doctor for advice on taking the necessary measures.
Seam sealing after ligamentotomy is a normal process.The forming scar is always dense; later it softens.The sutures heal in approximately three weeks.For some it is earlier, for others it is later.
Suppuration of the sutures indicates a bacterial infection, and it is not at all necessary that “an infection was introduced during the operation.”Perhaps the patient had a chronic infectious process.The infection is usually treated with antibacterial drugs.To prescribe them you need to consult a doctor.
Plaques should not appear after ligamentotomy.They, which cause curvature of the penis and its pain, are eliminated surgically during this operation.This is the proliferation of fibrous tissue in the tunica albuginea of the cavernous bodies.The main reason for their appearance is said to be microtrauma of the penis (usually during sexual intercourse) with the development of microhemorrhages, in place of which connective tissue areas are then formed.If plaques appear again, you should, firstly, see a doctor, and secondly, think with your doctor about what causes their appearance.
A scar may well appear after ligamentotomy, since postoperative scars form 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 resolve postoperative scars.If the scar bothers you greatly, you can consult a doctor about this.
Post-procedure care
In the postoperative period, analgesics may be prescribed to relieve pain.Dressings are done every 2-3 days, sutures are usually removed 14 days after surgery.It is recommended to avoid sexual contact for 1-1.5 months.
A mandatory postoperative stage for any type of operation is to first wear a stretcher (the first three weeks, sometimes for a longer time), then an extender; without this, the operation may be meaningless, since the ligament will heal along the line of the rupture 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 for wearing an extender is two months.On postoperative days it is worn for only one to two hours, later it is worn for six to eight hours every day.Be sure to take it off at night.
The ligament heals under the influence 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 need to stretch the penis gradually, carefully, avoiding pain, strictly following the doctor’s recommendations.Only a slight tension should be felt.
Reviews
Reviews about the operation are different.Some complain of complications, hematomas, and fever.Basically, such complaints are typical in the early postoperative period and should be addressed to a doctor.Each body is individual, 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%.On average, the surgery increases the resting length of the penis by 1–3 cm. Low satisfaction rates make this surgical technique unfavorable for many patients.
In addition, questions are often asked whether it is possible to lengthen the penis and increase its thickness at the same time.This is not recommended.Experts first recommend performing a ligamentotomy and, only after stopping all measures to stretch the penis in length using an extender that clamps the organ tightly, which is unacceptable to do after increasing the thickness of the penis, you can move on to the next stage.