July 19, 2014
Dear Dr. Reed,
Considering phalloplasty but have phimosis, advice sought
July 19, 2014
Good morning Mitchell,
Good question. By all means have a cosmetically performed circumcsion (as we perform it) to remove the phimotic scar).
Wait 3 motnhs and then have length and or girth as we provide.
Patients who have lengthening usually leave for home the next day. You could probably return to an office environment in 3 days.. Or consultation on Thursday, surgery on Friday. Monday, back to work.
From surgery anticipate a 3/8″ increase in length and with dedicated use of traction, 8 hours a day in divided sessions, anticipate a 1/8″ gain each month such that after 6 months you’ll have 3/8″ plus 6 x 1/8″ or 9/8″. We say about an inch longer erection in 6 months. Flaccid lengths will be correspondingly longer.
Please recognize that American Urological Association policy statement of 2008 remains unaltered? ?The American Urological Association (AUA) and the Urology Care Foundation consider subcutaneous fat injection for increasing penile girth to be a procedure which has not been shown to be safe or efficacious. The AUA also considers the division of the suspensory ligament of the penis for increasing penile length in adults to be a procedure which has not been shown to be safe or efficacious.?
Whenever you stop using traction whatever you have gained is permanently yours. If you continue, more length gains will be accrued. We do not do simultaneous surgery, such as any combination of length, girth of shaft, girth of glans, circumcision, or pubic liposuction.
Hardly a week goes by when some disillusioned patient done elsewhere calls us for a revision. And we told you so.
Generally speaking the penis does not appreciate simultaneous surgery with a few exceptions.
With AlloDerm, we can say quite conservatively you can anticipate a 3/4″ gain in circumference if you have not already had penile girth enhancement which is permanent as far as we know having followed patients for 8 years or so who have had AlloDerm. Most patients will do a lot better than that.
While you do not have to be circumcised for lengthening, you need to be circumcised for girth enhancement.
AlloDerm patients must be on strict bed rest with the exception of getting up to use the commode or eating in their room for 4 days. Surgery is the zero day, and we certainly recommend you stay at the Daddy O Hotel, one block from the office (305-868-4141) so I can see you daily as your penis will continue to swell for several days, and your dressing will be replaced often to accommodate a larger sized penis. Mention my name for a discount. Less expensive is tourist class Whitehouse Inn on the Bay (305-893-8280).
AlloDerm is like particle board, when immersed in body fluids, it swells and swells for several days. This spreading of the collagen fibers is helpful to permit ingrowth of a capillary bed and new cells of your own making.
Early mobilization is the great enemy of good graft take. Again plan on staying in your room, stocking up on food or sending out for food. Good Italian, Greek and Chinese restaurants abound with delivery service only a telephone call away. I’ve have been known to go shopping for some patients at Publix. You won’t starve.
If you have AlloDerm surgery on Tuesday, you could be back in an office environment on the following Monday. If you do manual labor you may wish to wait a good week after surgery and avoid trauma to your genitals. Most likely you will have many questions and we are available for consultation only, if that suits your purposes.
Candidates who wish to schedule surgery with our facility are required to have phone consultation with a favorable response to questions of concern. Assuming this, you will be given the nod to send in a 50% deposit which is non-refundable.
All patents will require these blood tests: a recent CBC, platelet count, PT and PTT. This can be done at our office the day before surgery or in your home town. These tests run about $100. If you are over 40 or are on medications, please call the office before scheduling surgery, as a letter of medical clearance may be required.
If you are a smoker, you must stop completely for 2 months before surgery (girth enhancement especially) and please never again.
Smoking causes vaso-spasm, impairs wound healing, produces excessive scarring, tissue necrosis, irritates and inflames pulmonary membranes and enhances anesthetic risk. However, most of our penile surgery is done under local anesthesia with IV sedation.
This goes also for any products containing nicotine or nicotine like agents including nicorette gum, nicotine patches, Nicotrol inhalers, and second hand smoke. Again not for 8 weeks before and not for 8 weeks afterwards. Hopefully never again.
Please no aspirin or aspirin products, no anti-inflammatory drugs such as Motrin, Advil, Alleve, or Cox 2 inhibitors such as Celebrex or Vioxx for a week before surgery. No Vitamin E or excessive alcohol or spices for a week before surgery as this may promote bruising. Bruising can be reduced (many believe) with Bromelain 500 mg 1 twice a day, Arnica montana (Boiron brand) dose 30C (take 4 small tablets sublingually, 4 times a day), vitamin C 500 mg (3 times a day) starting 1 week before surgery. Do take these medications unless there are specific reasons why you choose not to and let’s discuss it beforehand.
Boiron brand is available at Whole Foods and on the web at http://www.vitaminshoppe.com for “pennies” and we do notice a difference. You will need 2 vials. We hope to have the pleasure of serving you whenever your travel plans include the South Florida area.
Harold M. Reed, M.D. FICS
Senior Member of the American Urological Association
Member Society of Genito-Urinary Reconstructive Surgeons
Founding Member and Treasurer of American Academy of Phalloplasty Surgeons