Penile enlargement surgery should be considered in patients with true congenital penile hypoplasia (micropenis, normal build but size less than 2.5 SD below the normal mean). In fact, since most of the demands for this type of surgery come from patients who want surgical intervention due to penile dysmorphophobia and aesthetic considerations, this type of surgery can be considered aesthetic rather than reconstructive. In penile dysmorphophobia, patients are concerned about inadequate sexual performance due to the small penis size. Patients have lost their self-confidence, which can lead to social problems.
First of all, the patient’s psychological concerns, self-perception and expectations from surgery should be evaluated very carefully. There are two separate components in penis enlargement. Lengthening and widening phalloplasty. There are different techniques for this. As a result of the separation of the suspensory ligaments, a lengthening effect of approximately 2 cm is obtained by separating a part of the corpora from the pubis. If it involves the separation of the cavernous crura from the pubic branches, the advantage gained by providing more protrusion of the penis may turn into a disadvantage as an unstable penis facing down. With penile and scrotal skin remodeling, it is important to achieve a good esthetic result and to prevent subcutaneous tissue re-adhesion, and the infrapubic incision is routinely closed with reverse YV plasty (Z plasty). In selected cases, pubocavernosal silicone pad implantation and excision of the suprapubic fat pad can be added. For penis enlargement, different types of material tissue are required apart from the corpora cavernosa. Satisfactory early results reported with fat injection decrease with the onset of undesirable effects (scarring, swelling, infection). Alternative extracavernosal techniques require the use of free dermal matrix grafts or fasciocutaneous flaps. Liposuction or suprapubic lipectomy can be applied additionally. Penile thickening can also be done by using a saphenous graft.