T.E.P (tunica expansion mesh procedure) and implant journal

[IwillbeatPD]

One thing I don't quite understand is that you pump up and then can later put in another 15 pumps. Typically a person pumps up as much as they can, and later they can squeeze in two or three more partial pumps. If they wait another 15 minutes they might get in one or two more partial pumps, I don't think you're pumping up nearly as far as you can on your initial pumping.  The sooner you get all the possible pumps in, the sooner you start stretching, and the sooner you can deflate and get on with your day.

Maybe this also depends on implant size too. For me. I get maybe 15-20 full pumps before I can't pump initially. If I wait 10 min I'll get another 4-5. And seems like I can get another pump every 10-15 min after. I had this exact question though. From the initial pump, to the end of my hour cycling. I add another 10-12 pumps if I had to guess.  

[Stepone]

Jj21,
As all of us have said, it is all about the surgeon.
The sad part of your surgeries is that the doctor didn't seem to be patient focused.
I hope things will settle down. Your penis has been through a lot and things take time to heal.
Think about that.
As Hawk had pointed out, the pain is a good sign of stretching.
I would suspect over time, your penis exercises and hand modeling will give you more girth and straightness.
It's funny, but 2023 was my best penis year. lol
Each year gets better and better.
Best wishes for you and stay strong.
StepOne  

[jj21]

One thing I don't quite understand is that you pump up and then can later put in another 15 pumps. Typically a person pumps up as much as they can, and later they can squeeze in two or three more partial pumps.

Just to clarify, after 20m, it's probably 3-4 full pumps, then 8 or so half-pumps.  

[Aussiemale]

I am going to put this message here for others. I've spent about 20k on my surgery (2 surgeries) including airfares and accommodation. If I choose to get fillers to compensate for the lack of girth, that would cost another 10k. That's 30k AUD, another 10k and I could have just gone to Dr Hakky for my surgery, and I believe, I wouldn't have many of these issues.


I will post some pics up in a few weeks.
J

Hi JJ. Just read your post. Mate I would not risk getting fillers injected. You have an inflatable device inside you......what happens if they puncture the cylinder? Back to square one. Dont risk it mate.

 

[Sonic]

I would not get fillers if I were you J. It's just unnecessary waste of money and more risks. Based on your pics you have already gained some serious amount of girth compared to the pics prior to surgery, you have by my eyes at least doubled the size in girth. The most recent pics seriously look borderline porn star size.

Here is a side by side pic. https://ibb.co/gWf93Dr

[Aussiemale]

I would not get fillers if I were you J. It's just unnecessary waste of money and more risks. Based on your pics you have already gained some serious amount of girth compared to the pics prior to surgery, you have by my eyes at least doubled the size in girth. The most recent pics seriously look borderline porn star size.

Here is a side by side pic. https://ibb.co/gWf93Dr

Agree. I would be stoked with results. Don't let some cosmetic cowboy quack near it now.  

[Stepone]

Jj21

I agree, your cock is perfect.
Don't take any chances with additional surgeries or injections.
StepOne  

[jj21]

you have by my eyes at least doubled the size in girth. The most recent pics seriously look borderline porn star size.

Here is a side by side pic. https://ibb.co/gWf93Dr

Thanks Sonic, but just remember, with an implant, it takes an oval shape. So, from the top (as with the pic you linked), it will look girthy, as it is wide. However, depth, as in the girth from top to bottom, will be less than a normal round penis. I hope that makes sense.

I might think twice about fillers, I did just read that user trapper's fillers only lasted 6 months. I don't think it's worth spending thousands of dollars every six months. However, I have lost girth due to the retracted graft which is a bit difficult to see in pics.

I'll do some measurements once I properly hit 1 year (in a few weeks).

Thanks as always for the advice guys.

J

[Sonic]

Thanks Sonic, but just remember, with an implant, it takes an oval shape. So, from the top (as with the pic you linked), it will look girthy, as it is wide. However, depth, as in the girth from top to bottom, will be less than a normal round penis. I hope that makes sense.
J

Oh, I understand now. At the end of the day it's your decision bro, you do what feels best for you but I would again advise against it. It costs a bunch, they are only temporary and you already have way above average girth, just embrace the shape of your penis and live with it. I hope the other issues such as pain etc resolves and everything goes well. You went through a pretty rough process and I am happy things are starting to improve.

Honestly can't believe almost a year has already passed since you had your implant. Time really flies mate...

Btw, La Pump has an eliptical cylinder that has an oval shape. Maybe it could be an idea to try one and pump with it as your penis has more of an oval shape?

[jj21]

Btw, La Pump has an eliptical cylinder that has an oval shape. Maybe it could be an idea to try one and pump with it as your penis has more of an oval shape?

That's quite interesting, thanks for the info, I will definitely look into it.

Will post some pics of measurements in a few weeks.

J

[jj21]

Just going to leave this here. This was a reply from someone on FT. I think it's important info for people considering this procedure.



Re: Implant + TEP procedure Journal - 34yr old Australian
Sat Jan 27, 2024 11:21 pm

Glad you're better now. Really happy for you. I think your journal is one of the most important implant journals in the history of this site. No different than frequently referenced ones (e.g. Merrix, Tangerine etc.)

I'm not from the States. The highest volume surgeon in my home country offered me TEP with subcoronal incision. I was hesitant, to say the least. Long story short, I decided to go with Hakky. Flew from the other side of the planet to be implanted with a 26cm Titan. He used scratch technique, no TEP (which is an outdated technique according to him). He also told me that subcoronal incision can be extremely dangerous when it comes to a XL penis (especially +7"). It simply shouldn't be performed on a guy like me.

I'm not saying your journal is the only reason I changed my decision, but it played a crucial part in terms of forcing me to research TEP as humanely as possible.  

[Sonic]

I know which doctor implanted you. I know he's one of Australias most known and experienced implant surgeon. I was shocked he recommended the TEP procedure and more shocked with how careless he was after your problems arrised. If I need an implant I do not know what to do. The money required for surgeons like Hakky plus the travel expenses, I would have to save up for many many years. In Sweden they use AMS implants as far as I am aware. Also there is not a single ''high volume'' Implant surgeon in the country. Usually patients here lose 1 inches in size after being implanted on here.

I can only hope the VED helps in the long run. I have been to multiple urologists and I honestly don't even know if what I have is Peyronies or Corporal Fibrosis. My Erectile Dysfunction doesn't make sense. I don't now know if the Erectile Dysfunction is due to scarring or circulatory/vascular issues. At the end of a day I am a man, and refraining from sex as long as I have is starting to make me lose my mind slowly but surely.

I have lost quite some girth. I am using an LA Pump with the most narrow cylinder available, (1.5 inches) Roughly the same cylinder size as the Soma A cylinder. I am seeing slow steps in the right way but I'ts such a hassle. I have noticed that with the cylinder being so narrow it forces my erection to remain straight while erect in the cylinder. I can only hope that with the time and effort put in it will help ''remold'' the penis.

[jj21]

I can only hope the VED helps in the long run. I have been to multiple urologists and I honestly don't even know if what I have is Peyronies or Corporal Fibrosis.

I am really sorry to hear of your troubles Sonic. I know exactly what its like abstaining from sex (and not always by choice). It really takes a toll on your self-esteem, manhood, and mental health.

I am not sure of the details of your condition, but I do know that VED really helped me in the early days. Especially, the 3 Cylinder VED.

I understand your situation too, if I need a revision, my only option is to go to an Australian surgeon or wait a year and save up and see an American surgeon (waiting 1 year for a revision could pose its own problems). I heard Dr Antonini was good for Europe, but then I spoke to someone on FT who had a bad experience with him too. Being outside of the U.S, we really are stuck. And, you really don't want to have a bad result with the implant; its irreversible and our last hope. A bad result with the implant, just feels like the end of the road. So, you want to try your best to have the best possible outcome and this is highly dependent on your surgeon.

Someone like Hawk might be able to give you a better understanding on how an implant would affect corporal fibrosis.

Hang in there with the VED, and maybe try some traction. Also, the combination of pentox and cialis daily helped me quite a bit too.

J

[Hawk]

Sonic, I don't want to pull JJ's journal off-topic but IF you have ED that is not satisfactorily addressed by other means like Cialis, then an implant is your only option.  If you get a Boston Scientific (AMS) 700-LGX I find it difficult to believe you would lose length.  If you want to discuss your specifics in more detail, start a topic for yourself.

[GaussRifle]

Any update jj21 ? I avidly follow your journal ?  

[jj21]

Hey guys,

Bout to hit 1 year from my revision surgery (partial revision) and 17 months from my initial surgery.

I do have some good news, here are my dimensions (see pics):

L: Just over 6.5 inches (BPEL)
G: Just about 6inches (5.8 or 5.9? We use cms in Australia, hopefully I have measured correctly).

Just before surgery, I was 6.5 inches length and I never measured girth, however, I have included a pic from before surgery, in the third pic, you can see, the penis was quite narrowed out, especially at the base. I can confidently say, this looks like some significant girth gain. I was 5.3 inches girth and 5.75 inches length 8 weeks post-surgery (see beginning of this journal).

I am pretty happy with these dimensions. Thing is, almost 1.5 years post surgery, I am still getting pain when cycling, and the device seems to still be growing, albeit, very slowly. My completely layman and unprofessional guess, is that there was a lot of scar tissue and narrowing in my penis which is still stretching and/or due to the retracted graft on one side; growth is slower as one side is not stretching/inflating as much as it normally would be. It seems that, if the tissue can grow, and you keep cycling regularly; it will grow.

I have been cycling 1 hour twice a day. Most of my progress came within the last few months when I started this regime. I am thinking of switching to 30m VED and 30m Perito exercises soon. Simply because, 2 hours of cycling per day can really take up a lot of your time, and I am not sure how much more it will grow. Dr Hakky also recommended 30m VED.

These pics are about 85-90% inflation which is just comfortable for sex, it is not too hard or rigid but just mimics are hard natural erection, maybe slightly harder. 80% would probably mimic more of a natural erection, but not as hard, and slightly less girth.  I can get the girth to 6 inches on the dot if I pump it up more (95-100%), however, the device would be too rigid and hard for sex, and this level of inflation also results in less blood flow, and some loss of sensitivity. I did measure the girth in the middle when at a comfortable level of inflation for sex, and it is 5.75 inches and at the base is about 5.5 inches. The length is slightly over 6.5 inches, it looks shorter than pre-surgery, and I think that is just because of the thickness. I think a thicker penis just looks shorter. Please view my pre-surgery pics in this journal and you will see what I mean. I think the glans also seems bigger, may just be the pics but it looks that way. Pre-peyronies, I think I would have been around 7.2 or 7.5 inches length. Girth, I never really measured pre-peyronies, but I was told it was above average from women.

I will say that, I think 6 inches girth is really good. I was reading that at above 6 inches girth, some people can leave the penis in the vagina and make a woman orgasm just from slow thrusting. It reaches spots that aren't usually reached. Just what I have read.

I can also use VED pre-sex, and this results in probably 1cm extra in girth and 1cm extra in length. Can maintain this for a few hours after (without a cock ring). This is a good solution for guys that have lost a lot of girth to peyronies; pump up with the VED before sex. I might do this and post a pic just to show it's a viable solution for some.

These are the positives, and I am pretty happy with it tbh. However, there are some issues I have been dealing with which I will explain below.

Flaccid:

The device does stick out at about 4pm, and twists to the left when flaccid. As there is a strong kink/dog ear protruding out of the right, I can't wear anything other than thick jeans in public. If I wore shorts or trackies, it would look like I have an erection. This is an issue as I had a corporate job which required me to wear a suit. This has resulted in some huge lifestyle changes for me. Dr Hakky advised that this does happen, and it is dependent on the penis; each case is different. There is a surgery which may fix it, but it is not without risks. He advised it is a possibility to switch to AMS which would get rid of the dog ear. It just depends how much it is affecting my life. I am about to start a new job which requires me to wear a suit, and I am seriously considering what to do. My job requires me to go to court regularly, and it just would not be a good look if something was protruding out of my pants constantly. It's also a bit of a mental burden, having to worry about looking like you may have an erection.
When getting penile implant surgery, I didn't think I would be avoiding my niece and nephews beach parties because I can't wear shorts, or avoiding social gatherings when I can't wear jeans or stressing about a new corporate job because I could look like I have an erection in a suit.

A user on FT suggested a stretching pump device from Ebay. It seems to stretch the penis from the base. It is supposed to help, it worked for him. I just ordered and will try it out.

Dr Hakky advised some patients have this issue, it just depends on the penis, some stick out, and some don't. He has performed surgery to fix this issue in some patients, and in some, he has switched to AMS.
Please don't message me advising that there is nothing wrong with a bulge, as I agree with you. It's not a bulge that is the issue, it's the device/dog ear protruding out which looks like an erection through clothing (not a bulge).

Frenulum pain:

I do still get some pain by the frenulum. Dr Hakky advised that this was a common issue with the sub-coronal T.E.P with circumcision. He advised that he could perform a frenectomy (I think that's what it was called), or put grafting in the glans. He has come across this issue before and it is one of the reasons why he stopped performing sub-coronal incision; they just had too many complications.

Tubing:

There is some prominent tubing by the base of the penis when inflated, this can be felt when a woman is deep throating or you are deep thrusting. It also feels like some tubing is tangled or twisted in my scrotum – this can be painful and uncomfortable.

Peeing:

Unfortunately, after peeing, I get a mini stream dribble down after about 5m. Dr Hakky advised that this can be due to the large kink/dog ear, the urethra becomes bent. Can also spray in different directions when peeing. When I had peyronies, I would have  2-3 drops post peeing; this was manageable. I have spoken to some people on FT who had this issue after penile implant surgery, they just started sitting down to pee or using liners in their underwear. Bit easier to accept when you're 60+ and have a less active lifestyle.

I have considered doing kegel exercises, however, they are not recommended if you have tight pelvic floor muscles (I will explain below).

Prostatitis:

This issue is still here, I do have flare ups, they are painful, but can be managed with pain killers. Dr Hakky advised that this does happen, he had a patient that developed prostatitis post-surgery recently. He advised the medication regimen he usually prescribes, but unfortunately, he could not prescribe me anything as I am in another country.


Ability to discreetly pump:

The squeak is still there, it's a reasonably loud honk. I also must hold my penis straight when pumping otherwise it will pump bent to the left (no idea why?). I read a guy on FT who started holding his dick straight and pumping to avoid the device inflating to the left, and it worked. The fact that I have a loud honk, and have to hold my dick straight to pump it, makes discreet pumping almost impractical. However, it is possible to pump it up in the bathroom, tuck it up, and then go to engage in sex.

I can imagine, the guys who have no squeak, and the device pumps straight, would have no issues discreetly pumping.

Pain after ejaculation:

I still get pain after ejaculation, if I take a lot of NSAIDS pre-sex, the pain can be minimal. This could be prostatitis related, I am really not sure. It was a non-issue with peyronies. Sex is a bit difficult to enjoy when you anticipate pain. Also, having multiple rounds can be painful and cause a lot of discomfort.

Retracted Graft Issue:

The retracted graft issue is still there, albeit, with blood flow, it's only noticeable if I were to press on one side or hold it. I can press and feel that one side is softer than the other (as it does not inflate as much), and also slightly thinner.
I would be very happy if this issue resolved, as it would result in slightly extra girth, as well as a rounder penis.

Bend to the left:

See the discreet pumping paragraph above. If I don't hold my penis straight out and just pump, it will inflate completely bent to the left. Not sure why this happens, it's not a major issue as I can just hold it straight with one hand and pump with the other, but can cause issues if one wanted to discreetly pump.

Orgasm:

I have been having strange, weak orgasms, and I think this is due to a tight pelvic floor. When I orgasm my penis/perinium area seems to kegel. My guess, this could be due to nerve damage from surgery. I was doing some pelvic floor exercises (thanks to Dr Hakky's advice), and it did seem to help. There were some times where I had a normal relaxed and intense orgasm. I had to stop the pelvic floor exercises as on top of 2 hours cycling a day, I just did not have the time.

I will start the pelvic floor exercises again. Rolling was a good one.

Final thoughts:

I am happy with the device, I have my sex life back. The burden of peyronies is gone. You all know that feeling when you're out in public, you get attention from women, or you meet a girl and you develop a connection, but you have that burden of peyronies in the back of your mind. That feeling is now gone.

I have been struggling with a lack of a social life, if I can't wear thick jeans somewhere, I won't go. I worry at the gym, if my long top isn't covering my crotch, it could look like I have an erection. These are some issues that can really affect your quality of life.
If I didn't have the issues described, I would probably be on top of the world. After talking to Dr Hakky, he told me two things, that a sub-coronal incision, and leaving the devise inflated after surgery (mine was left inflated for 5 weeks as my Dr went on holiday), are both notorious for causing issues. Some of these issues I have, could be a result of these two things.

My advice for anyone considering this surgery is to really find a trustworthy doctor, if you can't afford one, consider whether it's in your best interests to wait, save up, and do the surgery overseas. Especially, if you have a complex case. I have had 2 surgeries already, and may have to have a third to fix the frenulum pain and flaccid issue. Had I just chosen to go to Dr Hakky initially, it may have saved me 2 surgeries plus a circumcision. Having multiple surgeries can really cause issues including scar tissue build up, risk of infection, losing bloodflow, nerve damage etc.

There is a story from Jordan Peterson's book and it tells of how his daughter Mikhaila had rheumatoid arthritis in her ankle, she had constant pain and discomfort. The first physician they went to wanted to amputate her ankle. The second physician they went to was able to snap a bone back in place, and this resulted in her pain being diminished and her being able to walk properly again.  This just emphasises the importance of choosing the right physician.

Unfortunately, Penile implants are not well understood, even by doctors who do the surgery. Doctors in Australia were not able to tell me what was wrong and tried to blame the issues I had on anxiety etc. It wasn't until I had 2 appointments with Dr Hakky that he advised these issues do happen, and they are common with sub-coronal incisions and leaving the device inflated for long periods post-surgery. The point I am trying to make is, as bad as this sounds, if you don't have one of the top surgeons in the world (find a world class surgeon as Merrix says),I really don't think you should trust your doctor. After having issues with my penile implant, I went to the top doctors in Australia, they all rushed me out of their office, said it was in my mind etc (kind of like when you first get peyronies and that urologist gives you cialis and rushes you out of his office. I also did my MRI here, I emailed it to Dr Hakky and he was disappointed, he said that the doctors here were looking for all the wrong things.

I really don't advocate anyone undertake the Tunica Expansion Surgery. I just don't think it's worth the risks. Dr Hakky also is against it, says its outdated and dangerous. He has his own auxetic technique and I think it's the scratching technique as well that he believes is a bit better and safer than TEP. I trust him, he just seems very ethical and knowledgeable. Only doctor who could tell me everything that was going on and reassured me that these things happen.

Finally, I would just like to say, don't take my post as being negative. I am actually quite happy with the implant. It has resulted in quite a few lifestyle changes, but that burden of peyronies which can leave a man depressed and suicidal is now gone. Sex is possible, and arguably, better sex, as I have a rock hard erection on demand, complicated acrobatic positions are even possible (lol), performance anxiety is a non-issue.

I just have some questions for anyone out there who has had to switch from titan to AMS. This may be my only way to get a flaccid that is able to be easily tucked in without a dog ear so I can wear suits and resume my corporate job:

1.   Did you lose much girth going from titan to AMS? I am quite happy with my almost 6inch girth atm.

2.   Did your penis become less round and more oval with AMS? I have heard this can happen.

3.   Did you have a dog ear? If so, how prominent was it? Please consider, if I did not have a dog ear, I could easily just tuck my penis to the left and wear a suit and resume my job. It's the dog ear that protrudes out and looks like an erection.

4.   My next revision will probably be the 24cm Titan, I heard the equivalent is 21cm AMS +3 cm RTE's, has the RTE's been an issue?

The community we have here has been more helpful than ever, thank you to everyone who supported me.  

 

[Pfract]

jj21!

Thank you for posting this update for us to know how you are doing. It was in such great detail... Just nice.

It is good to know that found the support you needed with Dr Hakky. I also found him very likeable when I had that video consultation with him a long time ago. Your next steps will require careful planning as like you said you already had a couple of surgeries and that takes it's toll on a person, not to mention the scar tissue on the penis possibly complicating further procedures.

I will leave it up to the implantees to answer your questions as they know better.

Stay strong man! Hoping one day you will find a resolution that allows you to fully be comfortable you have addressed these issues for good.

 

[jj21]

Here's my current comparison pic. Left is peyronies top view (the underside was very scarred which you can find a pic of earlier in this thread).

Right side of the pic is current, size is as follows:

Length: 6.75Inch BPEL
Girth: Top: 6inches Middle: 5.75 inches bottom: 5.5 inches.

My size with peyronies was  6.5 inch length BPEL and I estimate about 4.5 inch girth.

J

[Lostand Looking24]

My size with peyronies was  6.5 inch length BPEL and I estimate about 4.5 inch girth.

Is your current girth what you had before peyronies? I wasn't aware there could be that much girth loss with peyronies. Dents and hourglassing sure, but not the entire shaft girth  

[Pfract]

Incredible the difference it made on your girth!

[jj21]

Any tips on titan flaccid to hang more naturally?

I have been wearing a suit for work with loose boxers and even though the dog ear is concealed this way, the glans sticks out at 4 pm and can look awkward. Wearing tight boxers/compression underwear, the glans is pushed down but then the dog ear sticks out.

Issue is mostly on the right side.

Just started Perito exercises for 30-40m per day.

Any advice is appreciated.

J

[Stepone]

Jj21

I wear my penis to one side. After a while it will just curve that way.
When I get hard, it pumps out straight.
Years of wear will gradually make it easy and dog ears will soften.
I can actually wear boxer briefs now and it hangs with little notice.
Give it time my friend,
StepOne  

[jj21]

Thanks Step, appreciate your continued support. Hope all the other members are good, it's been a while.

As an update, I am pretty happy with my titan. The prostatitis is being managed with NSAIDS 4 x a week. It's actually a pretty amazing piece of technology when you think about it. at 80% my titan mimics exactly a natural penis. I really see how people grow to love their implant!

Just wish I could get my flaccid to point down or the dog ear to settle down so I can wear corporate clothes comfortably for work. Really the only issue I have at the moment.

Started perito exercises and will report back if they are of benefit.

J

[Pfract]

Interesting to know you have started the perito exercises. As far as I remember you are the only one trying this out. I am hopeful it brings you some improvement to your situation in the near future!.