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CST Web Exclusive: Phalloplasty technique provides aesthetic 'locker room' results

Article-CST Web Exclusive: Phalloplasty technique provides aesthetic 'locker room' results

The men’s room
Phalloplasty technique provides aesthetic “locker room” results

Karen Donley-Hayes
Staff Correspondent

Alexandria, VA — In the world of cosmetic surgery, there is one procedure that is flying under the radar — but word is beginning to get out.

Phalloplasty — loosely defined as a procedure that changes and/or enhances the form of the penis — may not be on the roster of services provided by most cosmetic surgeons, but it’s a specialty procedure one Va.-based doctor offers. Stephen X. Giunta, M.D., F.I.C.S., Aesthetic Plastic Surgery International, Alexandria, Va., has performed approximately 5,000 of them in the last 15 years.

Procedure Under Wraps
While phalloplasty can be performed for medical reasons (i.e., reconstruction following trauma, burns or disease process such as Peyronie’s disease), Dr. Giunta performs the procedure almost exclusively for cosmetic reasons.

He notes that, according to estimates, there have been about 30,000 phalloplasties performed worldwide in the last 10 years — but statistics are difficult come by.

“It’s a procedure that men do not talk about,” Dr. Giunta says. “Very few, I’d say less than one percent, will talk about it.”

In a world in which dissatisfaction with one’s penis is a man’s personal secret — and therefore not the topic of locker-room discussions and option-seeking from friends — how have Dr. Giunta’s patients found out about him and the services his practice offers? “Strictly through my Web site,” Dr. Giunta says. “I used to put ads in the local papers, but I don’t do that anymore because, for me, it’s become an international practice, and most of my patients find me through my Web site.”

A Staged Approach
Phalloplasty procedures have gotten a bad rap, he claims, largely because of surgical technique that resulted in unsatisfactory results. Dr. Giunta notes that many physicians try to accomplish the patient’s desired end result in terms of width increase via one procedure.

Dr. Giunta’s experience has been that results are much more satisfactory if phalloplasty is carried out in a staged approach. The original procedure (see At-a-Glance Phalloplasty Procedure chart below) includes lengthening of the shaft of the penis, and an initial autologous fat graft. If the patient desires more thickening, then — not less than three months from the first procedure — Dr. Giunta performs an additional fat graft. This staged approach, he believes, is much more successful because limited amounts of new tissue are introduced, allowing adequate vascularization and “take” of the graft. If one tries to accomplish the ultimate outcome all in one procedure, he explains, the result could be areas of nonvascularization with resultant fat necrosis and an uneven appearance to the penis.

Who Can — and Can’t
Dr. Giunta relates that his “typical” phalloplasty patient is the “everyman.” He comes from “All walks of life, all socioeconomic levels; age ranges from 18 years old to men in their 70s. The average age is 37,” says Dr. Giunta. “And the average length of time that men have been thinking about this before they do anything is eight years,” he adds.

Dr. Giunta feels that this may be a conservative estimate because many men are not even aware that phalloplasty is an option, “and a lot of doctors are still unaware.”

So who, then, would NOT be a good candidate? Aside from medical factors that would disqualify a patient from any elective surgical procedure, Dr. Giunta has other criteria that are important in qualifying patients for phalloplasty. “One of the main conditions for which I either reject or delay surgery is if a patient is severely obese,” because, in addition to the health factors associated with obesity, it also frequently comes with a significant degree of hidden penis, Dr. Giunta notes. “There are things we can do — liposuction, suprapubic lift, weight loss program — until we expect that the [phalloplasty] procedure can be reasonably successful.”

Dr. Giunta also will turn patients away, if necessary, based on their psychological situations. “It’s the person with unrealistic expectations as to what can and cannot be accomplished. Usually any experienced cosmetic surgeon can identify that patient.”

Strictly Aesthetics
So what can patients expect from phalloplasty?

Dr. Giunta tells his patients that, “Number one, phalloplasty is not a treatment for erectile dysfunction, other than possibly psychological[ly-based ED].” Cosmesis, not functionality, is the outcome. Results vary, of course, but typically, patients gain 2 to 2.5 inches in the flaccid length, and 1 to 1.25 inches in the erect length. “Interestingly,” Dr. Giunta notes, “at least 60 percent of my patients are looking for ‘locker room’ results more than ‘bedroom’ results. They’re much more concerned about nonsexual situations,” so this greater result as observed in the flaccid state is very satisfactory to them.

Dr. Giunta also stresses that the post-operative treatment plan — and patient adherence to it — is critical for a successful outcome. A tension device — to ensure that the lengthening and increased thickness are maintained during healing and after — starts after the swelling subsides, at about two weeks, four to six hours a day, and continues for at least two months. If the patient undergoes the staged approach and has a second fat grafting procedure, the same post-operative procedure applies.

Complications are rare, Dr. Giunta explains, but if a complication does occur, it’s usually in the form of an infection, deep in the incisional area, and not within the fat grafts. Any infection is treated with antibiotics and standard wound and/or incision and drainage procedures, if indicated.

When Enough Is Enough
Dr. Giunta explains that oftentimes a man’s dissatisfaction with his penile size is not based on actual measurements, but rather, on self-perception.

“I have a list as long as my arm of men who want more after already successful surgery,” Dr. Giunta says. “It’s overwhelmingly a perception problem. So they’ll come in wanting more, and I’ll tell them, ‘Enough is enough, you look great now. Most guys would kill to have what you have now.’ And they usually walk away happy with that.”

While phalloplasty may never be as openly discussed among men as, say, breast implants are among women, it’s clear that there is demand for the procedure — and that results can be very successful if performed by an experienced cosmetic surgeon using sound technique. CST

For more information
Stephen X. Giunta, M.D., F.I.C.S.
[email protected]

At-a-Glance Phalloplasty Procedure

  1. Light general anesthesia.

  2. Fat harvest — using the standard tumescent technique, obtaining long, thin strips via specially designed instruments.

  3. Preparation of the harvested fat under anaerobic conditions. Cleansed and centrifuged, then mixed with platelet-rich plasma (PRP) and 25% serum albumin — maintains the intracellular osmotic pressure, preventing apoptosis; also, the PRP adds growth factors.

  4. One- to 1.5-inch curvilinear incision above the penile-pubic junction, exposing the five ligaments anchoring the penis. The infundibular ligament is lysed with a laser. Dissection carried down to underside of pubic bone, where remaining ligaments are released via laser.

  5. Penis extended — inner penis curves, and this curve is straightened to gain length.

  6. Restabilization of the penis via attachment of the internal spermatic fascia and the lower part of rectus abdominus muscle to under-surface of the pubic bone.

  7. Internal bipedical fat flaps to cover the new length.

  8. Incision closed in layers until final suture.

  9. Through same opening, going posterior to interior, “tunnels” created in specific layer between muscle and fascia.

  10. Insert fat grafts with the controlled injector to gain width.

  11. Protective wrap placed.
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