Maximizing Length and Girth for Penile Implant Surgery
Maximizing Length and Girth for Penile Implant Surgery
For men considering a penile implant surgery, there are many questions regarding size. Surprisingly many surgeons will tip-toe around questions on length, girth, and sizing, but I believe they are important for patient satisfaction and the final outcome. You should have a clear understanding of what to expect in terms of size with a penile implant even before the implant surgery. Ultimately, there needs to be a level of trust between you and your surgeon. There are certain recommendations that I make to patients looking to maximize their length and girth with penile implant surgery.
Before Surgery:
1. Eat well. As with any surgery your body needs the optimal nutrients to heal and recover. I advocate for a high protein diet in the 4 weeks leading up to the surgery and the 2 months after surgery. If you have difficulty with eating a high protein and balanced diet, you may benefit from a protein supplement and a daily multi-vitamin. Protein, vitamin A and C, and Zinc have been shown to be important for wound healing. This will also ensure that the tunica has the right nutrients to stretch with cycling, similar to building muscle through weight training.
2. Quit Smoking. Nicotine and to a lesser extent THC has been shown to decrease blood flow, impair the immune system, and negatively impact wound healing. This translates to weaker and less flexible tunica that is more resistant to cycling of the implant. I typically recommend to stop smoking immediately or at least 2 months prior to surgery.
3. Vacuum Erection Device or Traction Therapy. I will get many questions about vacuum therapy or penile traction to help improve outcomes. My preference would be for traction therapy with lengthening (I have a few recommendations for doing this safely). This directly will stretch the tunica and surrounding tissue. However, you need to devote anywhere from 30-60 minutes daily for this purpose. A vacuum device can be used for lengthening as well for as little as 10 minutes daily. However this is more likely to cause laxity of the surrounding skin than true lengthening of the tunica. There are certain patients where the vacuum may actually be preferred (revision surgery, history of priapism or infection, etc).
4. Check your testosterone levels. The erectile tissues have many androgen or testosterone receptors. I’ve found in a large study that men with low testosterone levels might be at a slightly increased risk of implant infection (reference - https://pubmed.ncbi.nlm.nih.gov/35768026/) . Therefore, if you never had your testosterone checked in your lifetime, you should prior to surgery. If you are deemed a candidate for testosterone therapy, I recommend you have normalized levels for at least 4 weeks prior to the surgery.
During Surgery:
As your surgeon I will do everything in my power to ensure an excellent outcome for you and this includes trying to maximize both length and girth. Most implant surgeons size aggressively, but we do not want to oversize the implant as this can lead to many additional problems afterwards. Before I start each surgery and after you fall asleep, we will perform an artificial erection using a combination of saline and local numbing medication. This helps with pain control from the numbing medicine, gentle hydro-dissection of the corpora, and determine if there are any other issues that may not have been known prior to surgery such as penile curvature. This is not where you get sized. The actual sizing occurs when the corpora is open/exposed and I use a special instrument to obtain your custom measurements. Every patient is custom sized. After the implant is placed, I will test inflate the implant several times to ensure that I am absolutely happy with the final outcome and make any final adjustments before we close and wake you up.
After Surgery:
The time immediately after surgery (within 1-2 weeks) should be focused on reducing swelling and becoming comfortable with your new implant. Naturally, many men will focus on length and girth at this time, but I would say to take it one step at a time. You need to recover from the surgery itself first before you can rehab. Usually by 1-2 weeks, I will have patients start to cycle their implant daily (Try to inflate to a slightly uncomfortable sensation and then deflate). Similar to rehab after orthopedic joint surgery, the cycling is helping to reduce stiffness within the penis and allow additional stretch of the tunica. If you’ve been sized correctly by a high-volume surgeon, there should be some room for the implant to stretch the tunica both length and girth wise (even if you do not have a length expanding implant). Lastly, I recommend a low dose tadalafil or nightly sildenafil to begin when you start cycling to help improve blood flow and bring nutrients to the tunica during this rehab process.
With persistence with cycling and time, most men by 3-6 months after the procedure will gain back any potential loss in length. This implanted erect length is typically within a few millimeters of one’s natural erect length just prior to surgery. I say this all the time, but a penile implant is not designed to make your erection bigger, but it can make it as functional as a normal erection.
Contact me to schedule a consultation today so we can discuss on an individual basis the best strategies to maximize size with penile implant surgery.
