All surgery carries risks of complications and uncertainties. Mr Marcellino will thoroughly discuss those relating to your procedure with you at your consultation should you decide to take the next step towards treatment. An overview of the main considerations follows. Without prejudice to the below, please note that it is of paramount importance that you disclose your full medical history to Mr Marcellino.
Smoking increases the risk of complications, particularly infection, and slows the healing rate. It has been shown that a smoking patient has ten times the risk of developing complications than a non-smoking patient. This is because wound healing depends upon blood supply to the skin edges. Smoking induces a chronic state of vasoconstriction (reduction of the blood vessels calibre) with a consequent reduction of the blood supply. Each cigarette causes further constriction of the blood vessels. It is highly recommended that you quit smoking completely and immediately 15 days prior to surgery and for 15 days afterwards. No nicotine patches or chewing gums are allowed. If this advice is adhered to, the risk of infection and complications significantly decreases, but still remains higher compared to that of a non-smoker.
Post-operative follow-up is of paramount importance. Each patient undergoing penile enlargement surgery must come back as required to allow Mr Marcellino to inspect the wounds and provide further instruction. This instruction must be followed. Failing to attend your follow-up appointment can adversely affect the outcome of surgery and put your safety at risk. Following penoplasty, the patient is asked to return on specified appointments at intervals of approximately 7,15,30,90 days, or as required. Occasionally it may be necessary to return more regularly than the intervals stated. Transport is not provided by the clinic for postoperative appointments.
With penile lengthening one scar will be in the pubic area and the base of the penis with an inverted Y shape, another scar of a few millimetres will be on the abdomen area. However, with the advent of new techniques, Mr Marcellino may advise using a ‘short scar’ technique where possible, keeping this to a minimum. The quality of the scars will depend upon the skin of the patient and their ability to heal. For a few months the scars will be quite visible, but the tendency is for them to fade. Occasionally, if the patient produces excessive scar tissue, it may be prominent. This level of scarring is rare in Caucasian patients and slightly more common in black patients. The scars can be tender and painful for a while. A minority of patients may require scar revision under local anaesthetic several months after surgery. The second scar from the enlargement – an incision of 2mm at the base of the penis – is hardly visible. Any scarring is obviously less visible where pubic hair is allowed to re-grow.
All surgery carries the risk of infection. In order to reduce this risk, patients are given antibiotics intravenously during the operation and are discharged with a course of antibiotics to administer orally. Rarely, especially as a result of smoking, wounds become infected and need additional courses of antibiotics and a change of dressing to resolve this. In a few patients, the infection may be resistant to the treatment and may take a longer time to recover. It is important to maintain strict standards of hygiene in and around the areas being treated. In extremely rare instances, life-threatening infections, including toxic shock syndrome have been noted after surgery.
Following surgery the penis will be larger but It may be possible that skin irregularities, asymmetry, nodules, lumps and/or bumps will became visible and/or noticeable. The occurrence of any of these problems is not predictable. Approximately 20% of Mr Marcellino’s patients developed temporary lumpiness and/or asymmetries, but in only 1% were these permanent. Massages and cortisone injections will usually resolve these problems but in some case (the permanent ones, 1%) it may be necessary to perform additional surgery. Surgical revisions are usually performed under local anaesthetic as a day-hospital procedures.
During your consultation Mr Marcellino will show you what is achievable in shape with diagrams and photographs of previous procedures. It is important that patients who decide to proceed to treatment have realistic expectations of what can and cannot be achieved.
A haematoma is a collection of blood in the area of surgery (pubis, penis, scrotum). The risk is higher during the first 24 hours following the surgical procedure, but it may occur after this period. In case of a major collection of blood, it may be necessary to perform a second operation. The risk of bleeding slowly fades as the healing proceeds. Resting, and avoiding heavy lifting/physical activity are recommended in this period. Although extremely rare, bleeding may lead to a need for blood transfusion, which is a potentially life-threatening complication. You should not take any aspirin or anti-inflammatory medications for ten days before surgery, as this may increase the risk of bleeding. Non-prescription “herbs” such as St John’s Wort and dietary supplements can also increase the risk of surgical bleeding.
Fluid may accumulate in the pubic area following surgery, trauma or vigorous exercise. Additional treatment may be necessary to drain this accumulated fluid around pubic area or the foreskin of the penis. Where this occurs it may contribute to infection or other problems.
Skin Necrosis/Open Wound
The pubic skin (skin flap) may become ischemic (have a reduced blood supply) after the surgery, especially in smokers, and may not survive the operation (necrosis). This is an unfortunate situation, requiring extended disinfection of the wound. 6% of Mr Marcellino’s patients have experienced delayed healing, but, after a few weeks of regular medical checks, all of these cases have been resolved.
Some pain usually accompanies penoplasty surgery. The degree of discomfort experienced largely depends upon the pain threshold of the patient. Painkillers will be given after the surgery to control this, with an additional supply provided by the hospital after discharge.
Any general and local anaesthetic procedure carry a degree of risk. These include deep vein thrombosis, thromboembolism, pulmonary embolism and even death.
Depression is an increasingly common condition nowadays. Cosmetic surgery should not be seen as a cure for it, and a depressed patient with a “small” penis will likely remain a depressed patient with a larger penis. Cosmetic surgery, itself, can induce a mild depression for some time after the operation. Patients with chronic depression are not candidates for cosmetic surgery. However, in certain candidates, penis enlargement can have a positive effect on personal outlook, self-confidence and well-being. Counselling for such candidates both prior to and after surgery is key.
Swelling and Bruising
The pubis is a sensitive area of the body and has great potential to develop areas of edema. Some swelling and bruising are usually present after surgery. The operative site might stay swollen for a considerable time after treatment. Usually, they resolve within a few weeks, but, in some rare cases can take up to 2 or 3 months.
In Mr Marcellino’s patients, urinary retention has occurred in 0.5% of cases. Catheterization for 24 hours proved efficient in resolving the problem.
Mr Marcellino will discuss the matter of sexual function with all of his patients at consultation. It should be borne in mind that a longer penis may not necessarily lead to a better sexual life. The penis enlargement procedure has no effect on anatomical impotence. 1% of Mr Marcellino’s patients have reported some difficulty with erection persisting some months after surgery. Should problems with impotence be due to a bad self image because of penis size, however, the patient may benefit from this procedure.
Prominent veins are often a sign of poor blood flow and circulation. After surgery these veins may become more prominent. This risk must be understood and accepted by the patient.
Direct injury to the dorsal nerve of the penis can result in a loss of sensation to the dorsum of the penis and the gland and/or functional impotence. This complication is extremely rare.
A post-operative retraction in penis length can occur. This complication can be prevented, however, by performing daily physiotherapy for one month after surgery only the wound is completely healed.
Skin and penis sensitivity may change after surgery, ranging from total numbness to hypersensitivity and pain. This may last 6 months, one year or even longer. Surprisingly, some patients have reported an increased sensitivity to touch. Although there is no logical explanation for this, it is believed that the more distended fibers magnify the transmission of stimulus.
Areas where fat is harvested in procedures involving liposuction
Usually the fat is harvested from the abdomen area or the inner thighs. Further areas may be discussed with the patient. All risks related to liposuction will be discussed with Mr Marcellino during your consultation. Some of these risks are: swelling, bruising, permanent skin irregularities, pulmonary embolism, thromboembolism, deep vein thrombosis, lumpiness, permanent numbness, altered sensitivity, abdominal perforation, permanent skin folds, pain, discomfort, extended recovery time, asymmetry in volume/shape, loose skin.
Pubic Hair Positioning
The post-operative position of the pubic hairs may be lower and occur in areas where the skin was elevated and advanced during surgery. The occurrence of this is not predictable.
Skin Disorders/Skin Cancer
Penoplasty is a surgical procedure for the lengthening and enlargement of the penis. Skin disorders and cancer may occur independently of penoplasty.
In rare cases, local allergies to tape, suture material or topical preparations have been reported. Systemic reactions which are more serious may result from drugs used during surgery and prescription medicines. Allergic reactions may require additional treatment.
A review of the published medical literature regarding the potentially damaging effect on the function of the urogenital tract is insufficient to draw any definitive conclusions that this represents a problem. There have been reported cases of pain in testicles due to the increased size and weight of the penis applying pressure to the testicles.
Subsequent alterations in penis size and shape may occur as the result of aging, weight loss or gain or other circumstances. It will take a few weeks, and sometimes even months, for the new penis to settle and reach its final size and shape.
You may be disappointed with the results of surgery. Your expectations about what it would achieve may have been unrealistic Asymmetry in shape, the positioning of injected fat, and lumps, may occur after surgery meaning additional surgery may be necessary to improve your results. 2% of patients Mr Marcellino has treated did not achieve any significant increase in length after surgery. Additional surgery can rarely improve the length in these cases due to the anatomical features and scar tissue retraction.
Should complications occur, additional surgery or other treatments may be necessary. Even though risks and complications occur infrequently, those cited are particularly associated with penoplasty. Other complications and risks can occur but are even more uncommon. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee or warranty expressed or implied regarding the results that may be obtained.
The cost of surgery involves several charges for the services provided. The total includes fees charged by Mr Marcellino, the cost of surgical supplies, anesthesia, and follow up appointments. Additional costs may occur should complications develop from the surgery.