Guest Article By
Dr. Harold M. Reed, M.D.
Penile
enlargement fell into the lexicon of public awareness
in 1990 after a news story appeared in the Knight
Rider newspaper chain, dateline Miami. At that
time Dr. Ricardo Samitier had begun to inject
liposuctioned fat into the penis. Shortly
afterwards the press was advised that I was doing
lengthening.
When astonished patients were carrying to my office
clippings about Dr. Samitier from newspapers north of
the Miami Herald such as the Ft. Lauderdale Sun
Sentinel, I realized it was only be a matter of time
that the Herald would be induced to put together a
story.
My suspicions were confirmed after calling their
health editor. "Dr. Reed, we'll hold the
presses until I interview you and get your slant.
After that I assure you you'll never have to call a
publicist again." Her remarkable prophecy by and
large came true, lasting for 7 years. During this time
awareness swept rapidly like wildfire across lay and
professional channels alike. Mainstream urology
was cautious and critical despite the fact that
numerous lengthening articles had heretofore appeared
in their journals written by distinguished urologists
working out of university hospitals.
Based upon the attendance roster at a Palm Springs
meeting organized by Mr. Gary Griffin, a pamphleteer
of no small dimension, given to essays about male
genital size, 40 urologists and plastic surgeons were
poised ready to enter the fray.
One California urologist who proclaimed himself the
king of penile enlargement whooped up such a large
following, that he was unable to render dutiful post
operative care. His name is legion to the
forth estate and ultimately his license was suspended
and then revoked. A very handsome living could
be made just revising his procedures. I have
seen his "les miserables" as well as his
best work which is truly monumental.
Lesson: professional involvement must always remain
highly focused and personal. It's about a one-to-one
relationship that cannot be delegated easily to a
staff member or ghost surgeon. Humility must
pervade our relationship and representation at all
times. There has been a learning curve for every
doctor that started out in the early 90's. We
have learned to avoid patients with unreasonable
expectations as well as to realize the limits of our
own abilities.
Without trying to be iconoclastic, please realize
penile lengthening surgery produces only a 3/8"
gain in erect length at the time of surgery. Not much
more than that really. The root of the penis is
not a garden hose perfectly wound on a reel responding
to the slightest tug, spooling out yards and yards
conduit.
Lengthening comes about in a few ways. Firstly,
the arched position of the erectile bodies under the
pubic bone is converted to a straight line by
releasing that portion of the suspensory ligament
directly over the arch. The angle of an
erection's elevation is not changed appreciably as the
mooring of the first part of the penis's course is
still angulated. The penis when erect will be
more deflectable. We tell patients if they could
hang a bath towel over their erection without any
deflection, after release perhaps they could hang a
hand towel with similar persistence.
Secondly, lengthening is gained by use of a penile
traction device which must be used a minimum of 8
hours a day. That's a tall responsibility and
certainly patients who are unable to make this
commitment have no business undertaking release of the
ligament. The typical gain is 1/8" a
month. Thus after 6 months patients should have
an erection which is 1 inch longer (3/8" +
6/8"). When they stop using the
device, whatever they gained is theirs to keep
permanently. If they continue, length accrues at
1/8".
Some patients may have an overhanging and enveloping
prominent supra pubic fat pad which if removed will
recess the body surface line. This entity goes
by the name "concealed penis." It has
been said for each 35 pounds of weight a man loses,
he'll gain 1" in length.
Girth enhancement is brought about by placing an
additive under the penile shaft skin which is looser
and more mobile than skin elsewhere on our body. As
the skin covering the head (glans) is densely adherent
to the underlying erectile tissue, these
techniques do not adapt well to the glans. The rim of
the glans can be flared out somewhat as the glans is a
cap that overlies the distal end of the corporal
bodies.
Agents used to enlarge the shaft include liposuctioned
fat, AlloDerm (dermal matrix), and dermal-fat grafts.
Liposuctioned fat behaves unpredictably and may
reabsorb or form lumps called fibro-fatty
nodules. It has a touch up rate of 50%, AlloDerm
(a donated tissue product), is costly.
Ninety-five per cent may be gone in 2 years, but is
replaced by an ingrowth of cells of the patient's own
making. Dermal-fat grafts are taken either from
the lower abdomen or infra gluteal area (under the
buttocks).
In my hands, AlloDerm does not produce as generous a
girth enhancement as do dermal-fat grafts (3/4"
gain in circumference vs. 1 to 1 1/4"), but has
the clear advantage of avoiding a harvesting
incision. Despite perfectly approximated
skin margins, incisions heal variably. Some wind up as
the neatest hairlines you've ever seen, and others may
spread to 1/4" and develop a reddish brown
cast. Fortunately the ugliness is usually
only skin layer deep and can be trimmed and revised to
the satisfaction of most patients.
Postoperative erections are encouraged and patients
may have an orgasm whenever they feel up to it, but
please no penetrating sex for 6 weeks.
Lengthening is a very well tolerated procedure and
discomfort is controlled with a Tylenol or two.
When other procedures are done at the same time, the
discomfort level rises and even the best of well
intentioned patients will postpone the very necessary
immediate use of traction. When lengthening is
performed on a Thursday or Friday, most patients can
be back in an office environment on Monday. For
those who request girth enhancement, allow an extra 2
days.
While we have not seen any complications in the past 3
to 4 years relating to lengthening when performed as
an independent procedure, girth enhancement may
require a revision. Occasionally there are wound
healing problems, seldom of a serious nature.
As a general word of advice, when selecting a surgeon,
the less boasting and the more contact the physician
will allow the patient to have with him before
surgery, the more secure a prospective patient should
feel. In some offices workers perhaps more
properly called salesmen, are rewarded by commission
for their efforts and their language can get
hyperbolic.
The penis is an appendage, not the center of the
universe and does not appreciate too much surgery
being done on it at the same time. It is better to
stage and than to take what seems to be the easy way
out. Hardly a week goes by that I do not receive a
rueful letter from a disappointed patient who had a
case of "get-there-itis." One can
always negotiate a combined price with the doctor's
office manager.
Lastly, as any plastic or cosmetic surgeon will
advise, the great bugaboo of a great cosmetic result
is smoking. Aside from being one of the two most
common preventable causes of early death in the United
States (the other obesity), it is the number one risk
factor for erectile impairment. Seventy-five
percent of patients attending Boston University clinic
for erectile impairment had a history of
smoking. Fifty percent were past smokers, 25%
are active smokers. Imagine that.
Grafts do very poorly when blood vessels are spastic
and clamp down under the nicotine influence.
Nicorette gum is not an option as it works
similarly. My advice is no smoking for at least
2 weeks before and 2 months after surgery.
Patients should get a typed discharge instruction
sheet from their doctor and never take it on their own
to modify or change an order without first discussing
it with the doctor. Premature removal of a
dressing can be a horrendous mistake which may set a
patient back for weeks. One of my patients
couldn't wait on each visit to tell me how he was
altering my recommendations and all about the latest
creams and salves he was applying. Totally
wrong. Call first. You doctor should always be
available for a call or have someone in his office
that is capable of giving expert advice.
Lastly, after you have more or less (hopefully not
less) achieved the result you expected, forget your
penis altogether for a while except to use it.
You may have bragging rights, but neither you nor your
significant other should think of you as a penis. If
the only way you're coming across is on dick size,
you're running low on attributes and self-esteem.
An introvert with a big penis will always an introvert
be. Take time to enjoy others and make
others happy to be around you.
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Dr.
Harold M. Reed is a diplomate of the American Board of
Urology, and an active member of the American
Urological Association and American Academy of
Phalloplasty Surgeons. Graduating from the University
of Rochester and S.U.N.Y. Medical Center, he interned
on the Cornell surgery service at Bellevue Hospital,
and completed urology residency at Mount Sinai Medical
Center. He has received certification in post-graduate
microsurgery at Jackson Memorial Hospital. While a
Captain in the U.S. Army he served as a squadron
surgeon in Korea. Dr. Reed has authored several
urological papers and produced 2 genital
reconstruction videos, "Penile
Revascularization" and "Augmentation
Phalloplasty" (penis enlargement) both accepted
for viewing by the American Urological Association. |
Visit
Dr. Reed's site
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