Men have been preoccupied with the size of their genitals for thousands of years. Ancient Greeks believed that a small penis was superior to a large one. Moreover, some African cultures today use the term “large genitals” as a slur. However in Western cultures, men are not clamoring to have penis reduction surgery.

The predominant notions are that bigger is better, size matters, and the size of the penis directly correlates with male potency and prowess. Whether these notions are true or not matters little for most men since many believe in them so deeply. Many men feel that a penis of a certain size will better satisfy their lover or simply look more masculine in the locker room. Whatever the true reason, thousands of men request penis surgery for purposes of enlargement each year.

Penis surgery or phalloplasty is aimed at increasing the size of the penis. This can be an increase in length or girth (diameter). There are three main types of penis surgery that attempt to increase the length of the penis. The first is to simply remove fat from around the base of the penis thus revealing more of the penis. In overweight and obese men this can add length to the penis and is the safest procedure (though not strictly a penis surgery).

The second type of penis surgery involves cutting a ligament that suspends the penis. Once cut, the penis is held by some sort of traction (weights or suction, for example) to stretch the remaining attachments. Over time the penis moves out of its normal position and extends farther away from the body. While effective, it does change the look of the genitals.

The third phalloplasty involves the surgically attaching additional skin to the penis. This does not greatly change the length of the penis and can create cosmetic defects like abnormal hair distribution and scarring. It may not be an ideal approach to penis surgery. In fact, other than liposuction it is not clear whether penis lengthening surgery is actually effective.

From a surgical point of view, increasing girth is even more difficult than increasing length. The mainstay of treatment for increased penis girth is the injection of fat under the skin of the penis; however as much as half of the fat is metabolized after injection. This means that results diminish fairly quickly after the procedure. Experiments with dermal fillers are ongoing.

The other option for girth-adding penile surgery is penile implants. Penile implants were originally used as a treatment for impotence or erectile dysfunction before oral medications were available. Two semi-rigid implants are placed in the penis in the same tissue that normally fills with blood during an erection. The penis is essentially always at an erect length but can be moved into different orientations manually.

Penile implants have been adapted for use in penis enlargement surgery. The implants provide additional length and girth almost immediately. Also, additional size can be gained by adding skin flaps from other areas. Unfortunately the biology behind a penis erection is so complex and the tissue is so specialized that these penis enlargement surgeries will likely interfere with normal erections. Since penile implants are placed in the area that fills with blood, normal erections are no longer possible. This needs to be considered before consenting to penile implant surgery.

Not all cosmetic surgeons will perform phalloplasty. In general the most experienced phalloplasty surgeon will be a urologist and, even then, not all urologists will perform phalloplasty. Why not? The risks of relative disfigurement are fairly high while the aesthetic rewards are still minor. Significant trauma and a loss of physiological function can occur in people that are reasonably healthy (except for a belief that their penis is too small). Any good phalloplasty surgeon should describe all of the risks and choices beforehand and also exhaustively discuss the reasons behind the desire for phalloplasty. For some, it is best to speak with a mental health professional before contacting a phalloplasty surgeon.