Fat Injection to Penis phalloplasty is a surgical option for natal or trans men who wish to augment the male genital appearance. The primary goal of fat injection phalloplasty is to increase the girth of the penis. Autologous fat transfer is the viable surgical procedure for penile augmentation, featuring the injection of the patient’s own adipocytes to predesignated parts of the penis. The mechanism involves the collection of adipose tissue from selected body compartments, followed by a purification step aimed at separating the excess liquid and blood from the solid inert fat in the solution. The prepared fat is injected with thin, flexible cannulas in small aliquots until the desired penile girth has been reached. Also, the fat cells are injected into the penile tunics, rather than into the corpus cavernosum, to avoid impaired erections caused by embolisms. Although mostly indicated to increase the penile girth, fat injection is sometimes applied as a standalone or combined technique for residual or primary penis enlargement.
For more than three decades, reconstructive and aesthetic surgeons have carried out experimental phalloplasties on human cadavers and in animal research with desirable outcomes. Before that, they carried out autologous phalloplasty characterized by fat transfer, whose temporary augmentative effect was lost over time. As with every operative procedure, patient counseling in any of the abovementioned techniques is necessary, primarily with a focus on the potential risk of the procedure. Furthermore, multiple patient-related factors, psychological and somatic, need to be taken into account to finalize the best and most appropriate phalloplasty technique for every patient.
Identifying the most suitable candidates for penile enhancement is essential. Inclusion criteria will ensure patient safety and achieve satisfying outcomes in terms of girth improvement. Adult non-sick patients in good general health, always with a negative history of penile surgery, without any contraindication to general anesthesia, and who are psychologically ready to be submitted to a purely enhancing surgery could be potential candidates for fat injection phalloplasty. A multidisciplinary team should carefully evaluate individual cases.
A complete medical evaluation must be performed before the procedure to identify any risk factors and contraindications. We suggest advising patients with uncontrolled diabetes and/or cardiovascular diseases, bouts of previous thromboembolic disease, liver disorders, chronic or acute local infectious processes in the genital area, and sexually transmitted diseases to undergo specialist counseling and therapy before the procedure. We advise against performing phalloplasty with fat grafting when the body mass index is greater than 40. In such cases, we have not found it technically possible to harvest an adequate amount of recipient fat. Hence, related outcomes should be unsatisfactory. We suggest considering donor fat as definitely unavailable when BMI is less than 20. The capability of the donor sites is strongly related to the amount of recently harvested fat. A donor region is considered inadequate if less than 300 mL of fat is injectable after centrifugation. Unrealistic and uncontrolled expectations have already been described as the principal cause of dissatisfaction after aesthetic surgery. In our experience, an exhaustive interview performed at different times, fully calming down and consoling the patients, was often essential before obtaining final consent.
Recovery process – Managing swelling, bruising, and discomfort. Most swelling and discoloration diminish by the end of 1 to 2 weeks, but subtle swelling or edema might still be noted for the first several months. Soreness and discomfort at the operative site(s) can be significant for the first few days after surgery and greatly reduce over the weeks. Most patients are expected to return to non-strenuous work after approximately 2 to 3 weeks and gradually return to normal sexual function by 4 to 6 weeks as swelling and tenderness subside. Muscular (lower body) physical activity can be gradually resumed after 4 weeks, and non-contact sports can be gradually resumed 6 to 8 weeks postoperatively. Regular hygiene and limited incisional care are advised for the first 2 weeks. Regular urologic follow-up may be scheduled at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperatively at a minimum. Adherence is important. Additionally, some minor touch-up or fat clean-up may be warranted if not discussed in advance with the implanting surgeon.
In the rare instance a severe concern becomes evident (e.g., severe persistent wound drainage, excessive pain, accelerated swelling, color change of the penis, chest discomfort), you should seek medical advice. Milder concerns (disproportionate swelling, contusions, etc.) and questions may also be addressed with your surgeon. Using implanted devices will require 8 weeks for the surrounding swelling to diminish before they can be used. Regarding the injected fat, the amount placed initially is much higher than expected to remain since some of the volume may resorb over time after the process. Although resolution varies, appreciable retention is expected after 3 months. Once volume appears stable (ideally after 6 months at a minimum), a touch-up of additional fat may be feasible and is dependent on the surgeon’s preference as well as the patient’s desire. Moreover, it is important to have several follow-up appointments scheduled with your surgical team in the year after the procedure.
The aftercare following any surgical procedure is a crucial aspect of achieving the desired outcomes. Proper aftercare can help to alleviate complications and optimize patient satisfaction with the results. Proper wound care is a key aspect of the aftercare for fat injection phalloplasty. Keeping wounds clean and dry, as well as using prescribed ointments to help facilitate proper healing techniques, is crucial. In cases of self-donated fat in the phalloplasty, the erection should not occur in the first month, and the use of some non-erectile drug may occasionally be necessary, especially in the first days. The patient should be able to ask in real time for any discomfort or pain management. Another important aspect has been wearing support garments. The timely use and replacement of support garments should be discussed and scheduled together with the applicability of aesthetic revision operations, if desired. Patients are generally instructed to wear a support garment for four weeks postoperatively. The physical practices that support the healing process after phalloplasty include proper nutrition, hydration, adequate sleep, non-smoking, and avoidance of excessive alcohol consumption, as well as the incorporation of important physical activities in everyday life. Nutrition and hydration play an important role in the healing process. Patients are encouraged to drink plenty of water for the first few weeks following surgery to ensure proper hydration. Anti-inflammatory nutrition choices are highly recommended during this part of the recovery phase. Restriction from sexual activity should continue until the first postoperative consultation is held so that healing is consistently evaluated. In general, resuming sexual activity four to six weeks postoperatively is safe. The mental and emotional support that a patient receives both in the early postoperative phase and over time is crucial. As a healthcare provider, it is important to understand the support that is available to patients, including community resources, online peer connections, and one-on-one professional support. Access to these resources can be discussed at the time of surgery planning, and knowing where a patient is in relation to his assessment of postoperative body image and embodiment can help guide discussions. Follow-up consultation is also the ideal time to discuss any mental health concerns, assess adjustment, and assess the need for referrals to appropriate resources elsewhere in the healthcare community.