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Background <p>Postoperative retraction is a significant limitation of traditional penile lengthening procedures that rely solely on suspensory ligament release. This retraction can lead to dissatisfaction among patients seeking enhancement. To address this issue, a novel two-step lengthening technique has been developed, which combines suspensory ligament release with an autologous dermal-fat graft and reinforcement using spermatic cord-associated fat.</p> Objective <p>To evaluate the efficacy and safety of this innovative two-step lengthening technique in reducing postoperative retraction and improving overall patient outcomes in penile augmentation surgery.</p> Materials and Methods <p>Between September 2024 and March 2025, thirty-one adult male patients underwent suspensory ligament release via a reversed V-shaped suprapubic incision. The resulting retropubic space was filled using an autologous dermal-fat graft harvested from the lateral abdomen, customized to the assessed cavity volume. Transposed spermatic cord-associated fat pads were anchored to the base of the corpora cavernosa to reinforce the scaffold. Patients were followed up at 3, 6, and 12 months postoperatively. Penile length (flaccid and erect), complication rates, and patient satisfaction were assessed.</p> Results <p>All wounds achieved primary closure with no major complications. Mean flaccid penile length increased from 5.23 ± 0.58&#xa0;cm preoperatively to 6.89 ± 0.47&#xa0;cm postoperatively (<i>p </i>&lt; 0.001), and mean erect length increased from 7.78 ± 0.63 to 9.73 ± 0.71&#xa0;cm (<i>p </i>&lt; 0.001). No significant length loss was observed during the 12-month follow-up. Patient satisfaction levels were notably high, with 93.3% reporting satisfied or very satisfied.</p> Conclusion <p>This vascularized, multilayer autologous scaffold approach effectively stabilizes length gains following suspensory ligament release. It represents a promising and safe strategy to minimize postoperative retraction and enhance long-term outcomes in penile augmentation surgery.</p> Level of Evidence IV <p>This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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A Novel Two-step Technique for Penile Lengthening: Suspensory Ligament Release with Autologous Dermal-fat Graft and Spermatic Cord-associated Fat Reinforcement Prevents Postoperative Retraction

  • 期刊论文

  • 发表日期：

    2026年6月16日

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  • Qiyu Liu,
  • Yuchen Cai,
  • Wenjun Shi,
  • Li Yu,
  • Xueyao Cai

摘要

Background

Postoperative retraction is a significant limitation of traditional penile lengthening procedures that rely solely on suspensory ligament release. This retraction can lead to dissatisfaction among patients seeking enhancement. To address this issue, a novel two-step lengthening technique has been developed, which combines suspensory ligament release with an autologous dermal-fat graft and reinforcement using spermatic cord-associated fat.

Objective

To evaluate the efficacy and safety of this innovative two-step lengthening technique in reducing postoperative retraction and improving overall patient outcomes in penile augmentation surgery.

Materials and Methods

Between September 2024 and March 2025, thirty-one adult male patients underwent suspensory ligament release via a reversed V-shaped suprapubic incision. The resulting retropubic space was filled using an autologous dermal-fat graft harvested from the lateral abdomen, customized to the assessed cavity volume. Transposed spermatic cord-associated fat pads were anchored to the base of the corpora cavernosa to reinforce the scaffold. Patients were followed up at 3, 6, and 12 months postoperatively. Penile length (flaccid and erect), complication rates, and patient satisfaction were assessed.

Results

All wounds achieved primary closure with no major complications. Mean flaccid penile length increased from 5.23 ± 0.58 cm preoperatively to 6.89 ± 0.47 cm postoperatively (p < 0.001), and mean erect length increased from 7.78 ± 0.63 to 9.73 ± 0.71 cm (p < 0.001). No significant length loss was observed during the 12-month follow-up. Patient satisfaction levels were notably high, with 93.3% reporting satisfied or very satisfied.

Conclusion

This vascularized, multilayer autologous scaffold approach effectively stabilizes length gains following suspensory ligament release. It represents a promising and safe strategy to minimize postoperative retraction and enhance long-term outcomes in penile augmentation surgery.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.