Introduction To Penis Enlargement Surgery
Penis enlargement surgery (also known as penile
augmentation or penile enhancement surgery) consists of two
surgical procedures to enlarge the penis, one is used to
increase the girth of the penis, the second is used to
increase the length of the penis. Typically, patients opt to
have both penis enlargement procedures carried out at the same
Increasing the girth of the penis relies on fat cells
(usually from the patients abdomen) being transplanted
(injected) around the penis. The procedure, known as fat
transfer, bulks-up the penis and can increase the girth of the
penis by 1 to 3 inches. One of the possible drawbacks is that
the transplanted fat cells feel soft, somewhat like female
breast tissue. Additionally, increases in the girth of the
penis achieved this way can often disappear as the fat cells
are reabsorbed back into the body. Sometimes, the
re-absorption of the transplanted fat is uneven and the penis
is left looking lumpy and unsightly.
A variant of the fat transfer method called "dermal
transfer" may overcome the fat re-absorption problem. Dermal
transfer uses strips of skin and fat together. The skin stops
the fat from being re-absorbed into the body but because this
procedure requires strips of skin and fat to be grafted onto
the penis the surgery is more complex and the risk of
disfigurement is much greater.
Penis lengthening procedures are quite different from the
procedures used to increase the girth of the penis. The tissue
in the penis that fills with blood is called the corpora
cavernosa. This spongy tissue normally extends from the penis
back into the body. In some cases, half of the corpora
cavernosa may be "concealed" inside the body. Penis
lengthening relies on releasing this concealed tissue which
has the effect of increasing the length of the penis.
Releasing the concealed part of the penis is done by cutting
the suspensory ligaments that keep the corpora cavernosa
anchored within the body. This moves the concealed part of the
penis forward achieving additional penis length outside the
body. This type of penis enlargement surgery can result in
substantial flaccid size gains but sometimes only a small
increase in the erect penis length.
The side effects of this penis lengthening surgery stem
from the fact that with the suspensory ligament no longer
anchored to the pubic bone, the penis is effectively
"floating loose". If the penis is flaccid this will not
cause any problems but if the penis is erect then several
problems may occur. Floating loose from the pubic bone, the
erect penis can slip and shift around during sex. And without
the suspensory ligament to hold it, erections can point
downwards. Nowadays, more sophisticated surgical techniques
mean that this can be minimized but the angle of erection is
still likely to be reduced no matter how the surgery is
Penis enlargement surgery has advanced a long way since the
early days when penile disfigurement was almost a certainty
but many surgeons still refuse to offer penis enlargement
procedures because of the risks associated with it. Candidates
for penis enlargement surgery should seek advice from their
own doctor and ideally undergo counselling before consulting
with surgeons offering these procedures.
Penis size and enlargement surgery
Almost all men experience anxiety about the size or
appearance of their penis at some time. For most men, these
feelings will pass but, for others, they can be persistent and
A man's concern about his penis can lead to avoidance of
sexual relationships, and even of sporting and other
activities where other men might see him naked. Such men are
not only embarrassed by the apparent smallness of their penis,
but frequently also feel ashamed and silly about their
This article includes information about the size of a
so-called 'normal penis', about the abnormally small penis,
and about treatment.
Problems with judging penis size
Men generally fall into two groups regarding their penis
size and appearance. Some men have a short, fat, rather
elastic penis when flaccid that stretches and expands very
considerably during erection.
Others have a long, impressive-looking flaccid penis that
barely changes in size when erect, and simply becomes more
rigid. Men in the first group who see men from the second
group naked in the showers incorrectly think that they have an
abnormally small penis.
Both are normal, just different.
Obesity and very thick growth of pubic hair may make the
penis appear smaller. Obese men develop a pad of fat in the
pubic area and the flaccid penis becomes buried in it. Weight
reduction will improve appearance, as will neatly trimming
excessive pubic hair.
Very obese men might not be able to see their penis at all,
because of their large and pendulous abdomen.
Men should also remember that their penis will always look
shorter when they look down at it, compared with looking
straight at their penis in a mirror or across the changing
room at another man's penis. This is a simple optical
What is a normal penis?
When measuring penis size, it is important to distinguish
between the respective sizes of the flaccid, stretched flaccid
and erect penis.
Men'sy men are concerned about the apparent size of their
flaccid ('soft') penis, and worry that other men will laugh at
them in the shower, or that sexual partners will ridicule them
when they see them naked.
The flaccid penis varies considerably in size, ranging from
less than 5cm to over 10cm (2 to 5 inches). The size of the
flaccid penis does not determine the size of the erect penis.
Research1 suggests that the average size, measured from the
pubic skin (precisely where the penis joins the body) to the
opening (urinary orifice) at the tip, is about:
unstretched, flaccid length 8.8cm (3.9 inches)
stretched (pulled firmly out from the body), flaccid length
12.4cm (4.8 inches).
Fewer men seek medical advice about the length of their erect
penis. Masters and Johnson (1966) found that the size of the
erect penis ranges from 12.5 to 17.5cm (5 to 7 inches). They
also demonstrated that men with a smaller flaccid penis had a
proportionally greater increase in size on erection. The
average size of the erect penis, measured in the same way as
above, is around 12.9cm (5.2 inches).
What is an abnormally small penis?
No widely accepted definition of what is an abnormally
small penis exists, but guidelines for selection of men for
penis enlargement (penile augmentation surgery) recommend that
only those with a flaccid length of less than 4cm (1.6 inches)
or erect length of less than 7.5cm (3 inches) should be
considered for surgery.
Does penis size matter?
The answer to this question rather depends upon your
perspective. If you believe that you have a small penis, it
may matter very much to you, however unimportant the issue
might seem to others.
Some men become quite obsessed by the size of their penis
and will consider almost anything, including surgery, to
enlarge it. Most of these men will have a penis that falls
within the suggested normal size range, but that does not
always make them feel normal or better about themselves. Both
they, and their doctor, should recognise that this is
primarily a psychological problem, connected to physical and
sexual self-image, rather than a physical handicap.
Researchers have repeatedly shown that penis size does not
affect partner satisfaction during sexual intercourse. Some
men born with a severely shortened and malformed penis, even
less than 5cm (2 inches) long when erect, enjoy very
satisfactory sex with their partners.
Women are much more likely to be bemused by men's anxieties
surrounding penis size, than amused by its actual size.
Penis enlargement treatments
Treatments aimed at increasing penile length or girth can
be divided into two groups:
From ancient times, men have tried a wide variety of
treatments to enlarge the penis. Because of the sensitive
nature of the problem, and because of the surrounding shame
and embarrassment, concerned men are very vulnerable to
exploitation by the unscrupulous.
While most doctors and other healthcare professionals act
in a highly ethical manner, a few individuals will sell
remedies and even perform surgery that they know has no
evidence of long-term benefit. Some of them have been barred
from practice as a consequence of their unethical behaviour.
Others are still in practice, waiting to exploit the
unsuspecting by relying on the fact that they are likely to be
too embarrassed to complain to the authorities about an
A glance though the small ads in men's magazines will
reveal the following 'treatments' on offer:
weights that attach to the penis to stretch it
magnetic or electrical devices to stimulate penis growth
'hormone' therapy, sometimes containing testosterone or
related sex hormones (steroids)
remedies that contain assorted herbs from around the world.
Good-quality research evidence has not been published
showing that any of these treatments produce a sustained
increase in penis size.
Vacuum devices and weights may produce very small,
short-term increases in size, simply because the penis is
elastic and can be stretched. However, like an elastic band,
it snaps back with time.
More worrying are private clinics that advertise penile
augmentation (enlargement) procedures, and make extravagant
and misleading claims about their results. Surgery can be of
benefit to some men, but certainly not all of them.
Current cosmetic surgical procedures are largely unproven
by research, unreliable in their benefits, and may carry the
risk of serious complications. Urologists generally consider
this type of surgery to be still experimental in nature, and
not a standard procedure.2 Seek advice from a trusted doctor,
such as your GP or local urologist, about the nature and
standards of the clinic before asking for a consultation.
Since 1971, penile-lengthening surgery has been offered to
men with severe shortening due to congenital abnormalities
(abnormalities present from birth), surgery (for penile cancer
or Peyronie's disease) or trauma (accidental or deliberate
Cosmetic surgery to increase penile girth, or thickness,
began in the USA in the late 1980s.
Techniques for cosmetic lengthening were described in 1990.
More than 10,000 men have had such surgery, but reliable
information about results and complications have not been
published in a peer-reviewed journal (a journal where the
quality and content of the research is checked by independent
experts). Given the number of operations performed, this fact
is both astounding and worrying.
Penile lengthening: the most common technique to lengthen
the penis is to cut its suspensory ligament then perform
plastic surgery to provide additional skin to cover its new
length. The results are difficult to judge, as surgeons have
not collected data in a systematic manner. The results of the
only reliable study indicate that dividing the suspensory
ligament alone results in an average increase of 0.5cm (around
0.25in) in length, while skin advancement increases the length
gain to 1.6cm (around 0.75in). These figures do not compare
well with the claims made by some clinics. Some people,
undoubtedly, do better than average, while others do worse.
The suspensory ligament does have a role, in that it helps
keep the penis pointing upwards during erection. After it has
been divided, that support is no longer present. After
surgery, some men find that they have gained a small increase
in flaccid length, but the erect penis is about the same size
and now points towards the floor!
Increasing penile girth (thickness): this treatment may be
performed with a lengthening procedure or on its own. There
are two techniques in common use:
injection of liposuctioned fat, from the abdominal wall or
thighs, into the dartos fascia, under the skin of the penile
placing grafts of dermis (a layer of tissue from under the
skin surface that is well supplied with blood vessels) and fat
from the groin or buttock area within the penile shaft.
Complications following surgery
At least one person has died from bleeding after
augmentation surgery. Apart from the risks of infection and
bleeding, specific complications exist for each procedure.
Scrotalisation of the penis, in which the penis appears to
arise from the scrotum instead of the abdominal wall.
'Dog-ears' at each end of the operation scar.
Sloughing of the skin used to increase penile length (the skin
has a poor blood supply and therefore dies, leaving a deep,
Loss of girth due to fat reabsorption.
Nodule formation, if the implanted fat does not disappear
uniformly. The penis can be left with a deformed appearance,
with irregular fatty lumps all over it.
Some men are severely anxious about their penis size and
are prevented from enjoying a normal life as a result.
Men who are born with a small penis may benefit from
surgical treatment, but the results are unpredictable. Without
surgery, many will still be able to enjoy very satisfactory
sexual relationships despite the small size of their penis.
Men that are dissatisfied with the appearance of their
penis should think very carefully before requesting cosmetic
surgery, especially if the size falls within the normal range.
A better option may be to seek the advice of a sexual and
relationship therapist, who might be able to offer help and
Using surgery to treat a psychological problem is fraught
with risks. If surgery is the only way in which a man can
regain his self-esteem and improve his self-image, they should
seek advice from an experienced surgeon working in a reputable
Men should ask very carefully about the procedures that are
offered, the surgeon's results and any possible complications.
They would also be wise to ask another trusted medical adviser
for their view.