Management of Complications of Penile Augmentation
Mark P. Solomon, MD.
Private Practice, Bala Cynwyd, PA, USA.
BACKGROUND - Penis augmentation procedures have increased in popularity recently. The methods utilized include release of the penile suspensory ligament, the use of fillers, fat grafts, acellular dermal matrices (ADM), and implants.
METHODS - This report is a review of 64 patients who sustained complications from these methods of penis enlargement from 2009 to 2019.
RESULTS - The patients’ age at initial evaluation ranged from 19 years to 67 years (average 40.4 years). Follow-up after surgery was 1 month to 108 months (average 12.3 months). There were 39 patients who had complications of ligament release, 24 complications from ADM, 22 complications from free fat grafts, 13 complications from subcutaneous silicone implants, 6 complications from fillers, 5 complications from dermis fat grafts, 3 complications from silicone block placement, and one complication from a Nesbitt procedure. A total of 34 patients (53%) had more than one augmentation procedure prior to presenting for correction. The number of surgical procedures required to achieve the patient’s goal for correction ranged from 1 to 4. A total of 41 patients were corrected with one surgical procedure while 17 patients required 2 procedures, 3 patients required 3 procedures and 2 patients required 4 procedures. Eighteen patients sustained complications after surgery (28%). The most common complication after surgery was infection in 14 patients associated in all cases with an open wound proximal to the glans. Two patients had hematomas requiring evacuation. One patient sustained a partial skin slough. One patient committed suicide. There were no injuries to the dorsal neurovascular bundle. Methods for correction include scar release and revision length surgery, removal of grafts, implants, granulomas and injectable materials, and placement of ADM in a new surgical plane. Each of these augmentation methods requires an understanding of the penoscrotal anatomy as well as the biology of the implanted materials. Materials are often placed in the dartos layer and removal from this layer can cause ischemia of the shaft skin. Meticulous surgical technique is required to safely remove these materials including avoidance of subcoronal incisions whenever possible by using a scrotal approach or a pubic inversion method and protection of the dorsal neurovascular bundle.
CONCLUSION - As the number of these procedures continues to grow, plastic surgeons will be asked to manage problems similar to these. Surgeons need to be aware of these various conditions and the challenges required to manage them.
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