penisdoctor.com

February 9, 2012

Dear Dr. Reed,

Had a dermal-fat graft performed 3 years ago and the graft is mobile under the skin, not fixed.  Could use more girth.

Do I increase my risk in getting erectile dysfunction when I get into a second surgery or with alloderm.

Samel-ElHira

February 9, 2012

Dear Samel-ElHira,

While there is no significant increase if any on erectile dysfunction in that the graft is subcutaneous, there are more untoward cosmetic results with secondary and tertiary procedures in that the vascularity is less optimal, and tissue handling and surgical judgement has to be very apt.

If your graft is moving about, this suggested a poor vascular connection on its surface in some areas.  Dermal surfaces usually adhere quite well to the underlying penile skin.  If we place AlloDerm over this, what does this prognosticate for the success of our surgery?  Best to work with a clean base and healthy tissue.

Sincerely,

Harold M. Reed, M.D.
1111 Kane Concourse, # 311
Bay Harbor Islands, Florida 33154-2041

I have been interested in PE for quite some time but have put it off until I found the right procedure for girth. I stumbled across a Dr Lim I believe is his name (?). He performs a ‘flap’ surgery that carries more blood to the penis over time. He says the more you stay erect over this period of time the larger it becomes and stays that large. Have you heard of this? What do you think and have you tried this? They say it can be combined with other forms of girth enhancement such as alloderm or dermal grafts etc. What do you think about PLGA Scaffolds and the Elist implant as compared to the other forms of girth enhancements? My penis is average size but I would feel more secure if it were bigger especially in girth. I know I don’t want fat inserted. Thanks for your time.

Tyrole

Hi Tyrole,

I have never heard of him, honestly and the technique of flap surgery is not used by any urologist I know of.    Try to get some more background information, such as articles, photos etc.

We do know of PLGA scaffolds and the “implant” technique and do not recommend this.  I have seen others install PLGA scaffolds and the product is vey friable (tears easily) like an old dried-out sponge that turns to dust when rubbed the wrong way.  Unless great care is taken it may fall apart during installation.  Also be wary of simultaneous surgery.  The results can be anywhere from lackluster, to disastrous.   AlloDerm which we have used for 15 years is very reliable when properly installed.  AlloDerm can be installed via a tunnel and drag technique, for PLGA scaffolds the entire penile shaft skin (as a rule) has to be degloved and sewn back together again.

More involved.

Sincerely,

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
Founding Member Sexual Society of North America

QUESTIONS:i have dermal grafts and fat transfer,but the dermal graft is almost gone and the fat transfer is very insignificant, due to very low body fat.i would like to have the fat takin from my buttock area moved to my penise. how much would that be?  thank you…  Benson

Good morning Benson,

Thank you for your interest in what we do.

This is a story we are all to familiar with.  I could talk for almost 30 minutes about liposuctioned fat survival and the need for dermal fat grafts to secure excellent vascularization to survive.  (Been there, done that)  Most likely you not only have atrophy of the graft but perhaps a fibrous tether as well with some loss of penile length.

We are always responsive to patient requests, but we do make recommendations based upon 35 years of medical experience and common sense.

Please consider initiating a consultation with our office, could start out on the phone, as you do not want to continue to revisit your penis with one surgical procedure on top of another.

Our one time charge for consultation fee is 250.  If you do start with a phone consult there is no further consult fee once you come to our office, or any additional charge for followup questions.

Have a restful Sunday,

Harold M. Reed, M.D.

Phalloplasty Surgeon
305-865-2000

At 06:44 PM 2/14/2009, you wrote:

_________________________________________________

SURGERY:Penile Enlargement
OTHER_SURG:

Received a call last week from a patient who was unhappy with the contour of his penis post AlloDerm and also started to noted some hardness and some discomort, and wanted it removed.  Yesterday, call updated, leakage of fluid noted.  Patient will be seen ASAP this Monday and hopefully will have drainage of abscess and possible removal of an infected graft.  Every so often we see the occasional very affluent patient who says, “money is no object, put is as many AlloDerm pieces as you can.”

Please keep in mind overpacking the penis can lead to vascular compression and without blood flow, the patient is more likely to have an infection.   Moderation is always a good idea with elective surgery.

Avoid too much surgery on the penis at one time.  Can interfere with vascularization, so important for wound healing and lymphatic drainage.

Harold Reed, M.D.

Harold M. Reed, M.D.

AlloDerm has by far and away become the most popular way to enhance penile girth.  Sure we lived through the liposuctioned fat transfer years with the lumps and bumps and reabsorption and inevitable touch ups. and then dermal-fat strips for phalloplasty with the harvesting scars, our were neater than most have seen, especially those 1/2 inch wide violacious bands of Zoro on the lower mid back which fortunately the patient doesn’t have to see everyday.  “Dr. Reed, please mail me a copy of the photo you just took, I want to show it to my doctor.”

With AlloDerm you don’t have to worry about atrophy and fibrosis, as long as you don’t stack it, it’s already dead.  It is a sterile dermal matrix.  Cells of your own making will grow into it.  If a dermal-fat graft doesn’t get an optimal vascular hookup within the first five days, the final result can be anywhere from necrosis in an extreme example to length contracture with palpable tethers (fibrosis)  to fat atrophy.  I started out with a 6 1/2 penis and now have only 5 inches?

Oh, we’ll put some AlloDerm, over that.   Not such a good idea.   If there is a poor blood supply, the AlloDerm will not work.  AlloDerm always works best when it is supported on both sides by a rich vascular bed.

That is the key to tissue ingrowth.   That is the difference between a reach for the moon operation on the penis and phalloplasty performed by a phalloplasty surgeon.  Our phalloplasty pictures are available on our web-site, befores and afters.  Please be sure to click Next Photos (below each photo) for the whole gallery.

Harold M. Reed, M.D. FICS

305-865-2000

 Hi Dr. Reed,

I am a 35 year old white male in good physical health
albeit a little under weight for my 5 7 frame. I am very
curious to know how many of your patients undergo 
penile enlargement for no other reason than personal
satisfaction? I ask this because I want to be bigger 
just for myself. I guess it’s like buying a Mercedes
when your old car is just fine. You just want to feel
special.  

Does this kind of thinking bother you and do you try
to discourage people like me from surgery?      

Kal  

Dear Kal,  

For most, the operation (phalloplasty, augmentation phalloplasty)  is a cosmetic one and not
medically necessary.  I believe during arousal for both
your partner and yourself, being well represented is a turn-on. 

My responsibility is to tell you, you are normal if that is
the case.  Normal is a range that includes 88% of the all measured. 

We do note however, that a good majority of our patients
are below the median and can sympathize with their wanting to catch up.    

Please see our phalloplasty before and after photos and phalloplasty images.  The phalloplasty costs are posted on our web-site.

Harold M. Reed, M.D.

Dr.Reed,

My name is Stan. I am a 55 years old and very fit.  Approx 10 years I underwent lengthening and widening with dermal grafts. I was 5 7/8 erect and 4 1/2 girth. I am now 7 X 5 3/4 midshaft. As my wife likes girth and I am tired of using the pump. I am considering girth enhancement with alloderm.  The dermal seems to have decreased from just under the head to approx midshaft.  Can alloderm be used in conjunction with already placed dermal? As I want no more than 3/4 – 1″, to take out the dermal and replace with alloderm would make my girth less than it is now.  Also, how many sheets of allo do you typically use and what is the size of a sheet. 
 
Any information would be greatly appreciated. 

 

 

 

Hi Stan, 

 

We had had experience with AlloDerm for almost 10 years now and before that we did dermal-fat grafts, and before that transfer of liposuctioned of fat (autologous fat transfer or AFT) .  As a phalloplasty surgeon I evolved into the AlloDerm because it seems to be the most predictable performer.  Liposuctioned fat transfer can result in uniform or zonal reabsorption and the formation of fibro-fatty nodules or lumps under the skin. 

Dermal-fat grafts are living and in order for them to survive as soft as one might feel under the skin before surgery, they do need to pick up a sufficient blood supply.  Otherwise they will undergo some degree of atrophy which translates into fibrosis, the lowest common denominator of wound healing before necrosis.  Fibrous grafts tend to lose of course the original girth as the fat cells die off first, but worse yet they contract and result in shortened penile length. 

AlloDerm is a cadaveric product, and has no immediate biological requirements such as early re-vascularization.  If your dermal-fat graft in the distal shaft is not bothering you, you could consider Allo-Derm placed over it.  If it is truly fibrous, I would remove it, as AlloDerm should rest between a sandwich of healthy well vascularized tissue for a good take. 

We use extra-thick AlloDerm but avoid stacking sheets as this can predispose to a wound infection.  There is no blood supply whatsoever between the layers, and all it takes is a small amount of skin bacteria  which healthy tissue can repress.  The thicker a man’s penis is when he sees me, the less impact visually one extra thick layer of AlloDerm has.  Think of “a drop in the ocean.”  For men who have not had previous girth enhancement, we say about a 3/4″ increase in circumference.

Your circumference of 5 3/4 is OK and you may wish to rest on your laurels.  Most likely with AlloDerm you will get up to 6 or more inches.  In cosmetic surgery there is an expression, “less is more,” meaning that overdoing things can lead to complications.

Please do see phalloplasty before and after photos and images on our web-site.  The phalloplasty cost is also mentioned.

 

Hope this addresses your questions.  

Best wishes,

Harold M. Reed, M.D.

305-865-2000