A penile implant is a surgical device used to manage severe erectile dysfunction (ED) that has not responded to less invasive treatments like oral medications or injections. This procedure involves placing prosthetics inside the penis to allow a patient to achieve rigidity sufficient for sexual intercourse. The primary purpose of the implant is therapeutic, not cosmetic, and it functions to restore the ability to have a functional erection. This treatment is considered for permanent ED caused by conditions such as diabetes, vascular disease, or post-prostatectomy nerve injury.
Implants offer a reliable, on-demand firmness, providing a mechanical solution for patients whose natural erectile mechanism has failed. There are two primary types of penile implants, each achieving rigidity through a different mechanism.
Inflatable Penile Prosthesis (IPP)
The inflatable penile prosthesis (IPP) is the most common type and consists of a three-piece system hidden entirely inside the body. This system includes two cylinders placed within the corpora cavernosa, a fluid-filled reservoir, and a pump and release valve located in the scrotum. To achieve an erection, the patient manually squeezes the pump, which transfers saline solution from the reservoir into the cylinders, causing them to inflate and firm the penis. Pressing the release valve transfers the fluid back to the reservoir, allowing the penis to return to a flaccid state.
Malleable Implants
The second type is the malleable, or semi-rigid, implant, which consists of a pair of bendable rods placed in the penis that allow for manual positioning. The malleable device is always semi-rigid and is simply bent upward for intercourse and downward for concealment. Because the malleable implant has no moving parts, it has a lower mechanical failure rate than the IPP. However, the IPP offers a more natural-looking, completely flaccid state when deflated, making it the preferred option for many patients seeking the most discreet outcome.
Addressing the Question of Penile Size Increase
The definitive answer to whether a penile implant increases size is that it does not provide true augmentation beyond the penis’s natural dimensions. The device is designed to fill the space within the erectile chambers, known as the corpora cavernosa, up to the maximum stretched length of the penile tissue. A common misconception arises because many patients seeking an implant have experienced penile shortening due to the underlying ED or related conditions.
Conditions like Peyronie’s disease or long-standing ED can lead to fibrosis and atrophy of the penile tissue, causing a measurable loss of length over time. In these cases, the proper placement of a penile implant functions as “size restoration,” not augmentation. The device stretches the penile tissues back to their original maximum length, which can be perceived by the patient as a size increase compared to their shrunken, pre-operative state.
Objective measurements often show that the erect post-implant length is approximately equal to the pre-operative stretched penile length. Any small, measurable increase in length and girth is attributed to fully utilizing the existing tissue capacity and the stretching effect of the cylinders. The goal of the surgery is to maximize the restoration of the pre-disease dimensions, not to create a penis longer or wider than it was when healthy.
Factors Influencing Post-Surgical Dimensions
The final dimensions of the penis after the procedure are primarily determined by the patient’s anatomy and the surgeon’s technique. Before the surgery, the surgeon takes a precise measurement of the maximum stretched penile length (SPL), which serves as the blueprint for selecting the appropriate cylinder size. This measurement dictates the longest possible cylinder that can be safely implanted to fully utilize the available space.
A primary factor that can limit the restored length is the presence of scar tissue, or fibrosis, within the corpora cavernosa. Scarring from conditions like Peyronie’s disease or prior self-injection therapy can make the tissue inelastic, preventing the implant from fully stretching the penis to its original length. Surgeons aim to overcome this by using the longest possible cylinders and sometimes employing specialized techniques to maximize the space.
Post-operative care also plays a significant role in achieving maximum restored length. Patients are instructed to begin a regimen of inflating and deflating the implant, known as cycling, within the first several weeks after surgery. This action helps to remodel the healing tissue, actively stretch the penile shaft over the cylinders, and maximize the final functional length.
Procedures Focused on Penile Augmentation
For men whose primary goal is a cosmetic increase in size, procedures other than penile implants are used. True penile augmentation procedures are specifically designed to increase length or girth in a non-diseased penis. Lengthening procedures often involve surgically releasing the suspensory ligament that anchors the penis to the pubic bone, allowing more of the internal penile shaft to hang externally.
Girth enhancement is typically achieved through injecting materials like dermal fillers or fat harvested from the patient’s own body into the penile shaft. These cosmetic procedures carry different risks and outcomes compared to implant surgery, which is an established treatment for ED. A penile implant remains the standard for treating severe erectile dysfunction and provides functional restoration, not cosmetic augmentation.