Penis enlargement surgery can involve silicon implants, fat transfer, ligament division, and other procedures. Surgery is rarely necessary in medical terms, and it can entail complications.

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Although penis enlargement surgery may work in some cases, there is no guarantee that it will be effective, and the procedures carry some risks.

Most people who opt for the surgery have a normal, functioning penis, making the surgery cosmetic. In these cases, the cost can be a barrier for many people.

This article discusses what penis enlargement surgery may involve, its effectiveness and risks, and the costs of the procedure.

Penis enlargement surgery is a procedure that aims to increase the length or girth of the penis.

Surgery may involve the insertion of silicone implants, the transfer of fat cells, or the use of skin grafts to increase the size of the penis. Other approaches may take the form of cosmetic surgery to give the appearance of a longer penis.

The true need for penis enlargement is rare. According to the Urology Care Foundation (UCF), surgery is only necessary if a person has a condition called micropenis. This term describes a penis that is 7.5 centimeters or shorter when stretched.

A penis that functions adequately for both sexual intercourse and urination does not require surgery. The authors of a 2020 review noted that the majority of those seeking treatments for penis size have a penis within the normal, functioning range.

The same researchers attribute this finding to the ill-conceived notion, reinforced by pornography, that sexual fulfillment depends on the size of the male phallus.

There are a few different procedures for penis enlargement surgery, each of which has its own method.

Silicone implants

This type of surgery involves the insertion of a crescent-shaped piece of medical-grade silicone under the penile skin to make the penis longer and wider.

Currently, the Penuma procedure is the only penis enlargement surgery that the Food and Drug Administration (FDA) has cleared for commercial use under the 510(k) regulation.

A surgeon first makes an incision above the penis and then inserts a silicone slip through it onto the shaft of the penis. They will shape the silicone implant to ensure that it fits the size and shape of the penis.

Fat transfer

During a fat transfer procedure, a surgeon will remove fat cells from a fatty area of the body and inject them into the shaft of the penis.

They do so by making small incisions into the sides of the penis and injecting purified fat cells into these areas.

Suspensory ligament division

Suspensory ligament division surgery, or ligamentolysis, offers a way to make the flaccid penis appear longer by cutting the suspensory ligament. This ligament attaches the penis to the pubic bone.

During the procedure, the surgeon will sever this ligament and move skin from the abdomen to the shaft of the penis. Although this may make the flaccid penis hang further down, it does not actually increase its size.

The surgeon may also recommend other procedures, such as removing fat from the area surrounding the penis. Doing so may make the penis appear larger, but again, it does not actually change its length.

Other augmentations

Other, less popular augmentations include:

  • tissue grafts
  • hyaluronic acid injections
  • polylactic acid injections
  • penile disassembly

According to the UCF, almost no method of penis augmentation works.

Currently, the Penuma implant is the only FDA-approved cosmetic surgical procedure to increase the size of the penis.

A 2018 study notes that the Penuma device demonstrated an average 56.7% increase in the girth of the penis, as well as high patient satisfaction and improved ratings of self-confidence and self-esteem, even after long-term follow-up.

Additionally, the Penuma process may aid with conditions affecting the penis. A 2019 study notes that using a silicone implant helped correct a retractile penis, allowing more of the penis shaft and glans to be visible.

Another 2019 study found that cosmetic penis enlargement using a combination of a silicone spacer and fat transfer provided satisfactory results. The procedure increased the length and girth of the penis and improved its function, even 12 months afterward.

However, there is no guarantee that penis enlargement surgery will be effective.

Penis augmentation via injecting fat cells may not be satisfactory in many cases. Research suggests that the body may reabsorb or break down roughly 30% of the injected fat within the first 2 months. A 2017 review suggests that the fat graft may decrease in volume by 20–80% within a year.

The same review also notes that the outcomes for people undergoing suspensory ligament operations are not consistently favorable either. Patient and partner satisfaction rates for this procedure range from 30–65%.

Learn more about sexual compatibility and penis size.

The American Urological Association considers neither fat injections nor suspensory ligament division procedures to be safe or effective.

Conversely, a 2019 study suggests that penile cosmetic enhancement surgery is, for the most part, safe and that it is becoming safer. However, the authors note that complications may still occur.

Every step of penis enlargement surgery has some risks, including possible side effects.

Adverse changes included sexually disabling penile deformity and severe shortening, curvature, edema, subcutaneous masses, infection, non-healing wounds, and sexual dysfunction.

A person may experience:

  • bruising at the operation site
  • bruising along the penis
  • changes in the shape of the penis
  • bleeding at the incision
  • infection
  • swelling
  • temporary loss of sensation in the penis
  • pain with erection
  • scarring

A small 2018 study into the complications of penis enlargement surgery reported that some study participants experienced curving of the penis, sexual dysfunction, and wounds that did not heal.

There are also some operative requirements to consider before surgery. For example, the person must already have had a circumcision to undergo enlargement with silicone implants. If not, they will require circumcision before proceeding.

There are also risks from using anesthesia during surgery. These side effects can include:

  • problems with heart rhythm
  • allergic reactions to anesthesia
  • confusion upon waking up from sedation
  • awareness during surgery

People with sleep apnea may be at a higher risk of complications during and after having a general anesthetic. This is because anesthesia can make the throat close up and make it more difficult to wake up and breathe after surgery.

The typical downtime after surgery is relatively long to ensure that the penis heals correctly. Experts recommend 30 days of no intense physical activity and 60 days of no sexual activity or masturbation after cosmetic penile enhancement surgery.

In most cases, penis enlargement surgery is a cosmetic procedure. Most insurance policies do not cover cosmetic surgeries such as these, so the person will have to pay out of pocket.

As a result, penis enlargement surgery can be expensive. The procedure itself can cost thousands of dollars, and a person also needs to factor in the cost of taking time off work and other activities to recover.

Insurance may cover the surgery in cases of true need, such as to correct disorders that disrupt the function of the penis.

Below are some of the top frequently asked questions about penis enlargement surgery.

Does penile lengthening surgery work?

The Urology Care Foundation writes that the only medical reason for penis enlargement surgery is to treat micropenis. It also notes that fat injections and suspensory ligament division may not be safe or effective.

A person should talk with a doctor to discuss the benefits and risks involved in the type of penis enlargement surgery they are considering.

How long does it take to recover from penis enlargement surgery?

A person can expect a relatively long recovery time after penis enlargement surgery. Research suggests a person should not engage in intense exercise or sexual activity for 30 and 60 days, respectively.

A person should work with a doctor through their recovery period to ensure that their penis is healing correctly.

Penis enlargement surgery can be effective for people who have medical issues that affect the function of their penis. However, surgery is not advisable for someone with a functioning penis in the normal size range.

For this reason, insurance is unlikely to cover cosmetic penile surgery, but it may cover some costs if surgery is necessary.

Even successful penis enlargement surgeries carry the risk of side effects and other complications. A person should work closely with a doctor in each case to discuss all the possible risks, as well as the likelihood of success with each procedure.

Having a candid conversation with a urologist to discuss goals and expectations will help a person make the most informed choices, which often leads to the best clinical outcomes.