Nuances and Variations of Penile Implant Surgery

[Hawk]

Since men often incorrectly think of an implant almost like an artificial penis, maybe it would be more accurate to call it an "Implanted Inflation System."

Anyone who can't reliably have mutually enjoyable intercourse due to Erectile Dysfunction or Peyronies Disease will be happy with a functional implant. Also, since most men with an implant have not seen other implanted penises (at least in person), they have nothing to compare.  The point of this post is not to rob anyone of joy.  A penis with an implanted erection system is usually 1000% better than before, and you should focus on that and capitalize on those vast improvements.  There are, however, nuances that make an implant closer to a "perfect implanted erection system".  I want to cover some of those and maybe add to it as time goes on.  Keep in mind that all of these can be missing, and many will still be 1000% better than before the new erection system.  The importance of these varies with the patient and his partner(s).  I think single younger men are likely to be more concerned with some of these.

Nuances in Outcome

1. No Rear Tip Extenders - RTE's are discussed in detail, so I will be brief.  There are times that one pair of RTE's is unavoidable, but RTE's do not inflate.  They are smaller in diameter than the cylinders, so they are less firmly planted in the crus.  This means an inflated implant is more likely to angle toward the floor (below 3:00).  It also moves the tubing connection on the base of the cylinders forward.  This means there is more chance that the tubing from the scrotal pump to the cylinder base could be more detectable either by feel or even visually.  

2. Scar - Most all scars from an implant are essentially undetectable.  Scars from a scrotal approach are TOTALLY undetectable with a magnifying glass if they are vertical on the seam (raphe) of the scrotum.  A coronal approach is usually hidden in a circumcision scar, and a retropubic approach is usually hidden by pubic hair.  Most men are not vain enough to care if they show a slight scar from a horizontal scrotal scar or a slight scar that shows through clipped pubic hair.  It just makes them look more manly.

3. Hidden tubing - This is addressed under items one and two.  The tubing at the base of the penis is harder to conceal with RTE's and a retropubic approach.

4. Proper sizing.  Since oversizing is a medical complication, less experienced surgeons are more likely to undersize for fear of oversizing an implant.  This means some reduction in length and CAN mean a droopy glans.  It is referred to as the Concord effect after the nose profile of the Concord supersonic passenger jet. A skilled surgeon will never have this.  A few surgeons will sometimes even go up one size in implant and trim the base down to avoid RTE's or under-sizing.

5. Straightening - Is your surgeon prepared to address straightening with the implant, or does he want to do separate surgery to address straightening?  More surgical time equally more healing and more chance of infection that requires the removal of the implant.

Nuances During Recovery

The next list does not affect the ultimate outcome of your penis.  They are just post-care and recovery issues to consider when choosing an implant surgeon.


A -  Will you be sent home partially inflated, fully inflated, or deflated.  If not deflated, then how long will you be that way?  Are you prepared to make provisions with work and family to address this? *** Being sent home deflated and not cycling in the first two weeks can cause scarring and permanent shortening.

B - How soon will you cycle, be able to soak in a tub, have intercourse.  If you have dealt with penis issues for years, you can probably wait another 3 months, but 3 weeks is certainly nice.

C - How accessible will your surgeon be when you are nervous and have pressing questions.  It ranges from: You cannot talk to them, to getting a response from a nurse or PA in a day or two, to having your surgeon personally answer his cell phone or return your call within 15 minutes if he is not in surgery.

[Mikel7]

II think you need to sticky this somewhere within the implant "stickies" or have it as a standalone.  The changing of the terminology brings a new light into the conversation. It exposes possible problems to avoid and members should be aware of them.  Don't let this get burried in the forum.

[wolfpacker]

The next list does not affect the ultimate outcome of your penis.  They are just post-care and recovery issues to consider when choosing an implant surgeon.

B - How soon will you cycle

Great points overall, but I do disagree with the selection above in point B. Being able to activate the implant and begin cycling soon after implantation can definitely have a big impact on your final size. If you don't activate and cycle soon, scar tissue forms around the implant and limits future expansion. This is the reason that Dr Eid activates his patients on day 3 after surgery. Some doctors choose to activate after 6 weeks or more, even though it was shown in the study below that this will contribute to losing final size:

https://pubmed.ncbi.nlm.nih.gov/25017596/

[Hawk]

Wow, Wolfpacker, That is a pretty impressive first post.  Where have you been?  Since we have not heard from you sooner, I assume this is the first time I have been in error in the past two years.  

Thanks for jumping in with your comments.

I appreciate you pointing out a misunderstanding that I might cause because I was unclear in my post.  Some men are sent home inflated, so early cycling is less crucial to penis size for those men, BUT the patient then has the potential of the reservoir scarring in too small.  The result is auto inflation.  For the men sent home deflated, early cycling can have a significant impact on final penis size.  Thanks to you, I amended my original post.

Dr. Eid "A long wide penis with deflated cylinders may retract by as much as two inches. If the implant is not inflated early in
the immediate two weeks after the surgery, it may heal in this foreshortened dimension, causing permanent deformity
and reduced inflated length. In order to be able to inflate early, one must be able to feel all of the components of the
pump, inflating bulb, and deflation footprint. "