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Guest Article

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.

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