Augmentation Phalloplasty Surgery for Penile Dysmorphophobia in Young Adults: Considerations Regarding Patient Selection, Outcome Evaluation and Techniques Applied

To report on the efficacy and safety of augmentation phalloplasty procedures in physically normal young men, to introduce a patient selection and outcome evaluation questionnaire as well as, to propose a surgical technique modification. Eleven (11) out of 28 psychosomatically normal men (25–35 years) who presented complaining of penile dysmorphophobia (subjective perception of small penis), were subjected to: (a) penile lengthening (suprapubic skin advancement – ligamentolysis): n = 5, (b) penile lengthening and shaft thickening (free dermal-fat graft shaft coverage): n = 3 and (c) panniculectomy – suprapubic lipectomy and penile lengthening: n = 2. A self administered questionnaire was employed in order to facilitate selection of the patients qualifying for the operation as well as to evaluate the outcome. In addition, a technical modification regarding dermal-fat graft handling was applied. The postoperative course was uneventful with minor complications. The mean penile length gain (flaccid - stretched penis) was 1.6 cm (1–2.3 cm) [ p = 0.0014], the mean circumference gain was 2.3 cm [ p = 0.003] at the base and 2.6 cm [ p = 0.0012] subcoronaly. Significant (20%–53%) [ p < 0.0001] sexual self-esteem and functioning improvement was reported by the majority (91%) of patients. Although penile size alteration was not spectacular or satisfying the patients’ “great” expectations, the substantially uneventful clinical course coupled with the significant improvement in sexual self-esteem and function and the highly accepted outcome by the patients, render augmentation phalloplasty reasonable treatment modality for the management of strictly selected and thoroughly informed young adults who suffer from penile dysmorphophobia.