The Removal of Rigid Silicone Implants, and Any Subsequent Revision or Repair

(1a) Dr. Solomon, I've read that you perform the removal of rigid silicone implants, and any subsequent revision or repair . Here is a 4-Part Question:

(i) Would you advise patients who've had a rigid silicone implanted for penis enlargement to have it removed, even if there is no clear indication of complication or initial dissatisfaction (i.e. preemptive removal)? If so, why?

Patients often ask this question. I have seen only one man for whom my answer was to leave the device in place. He had no symptoms and no evidence of erosion or malposition of the device. I do caution men that if the device becomes more visible because of thinning of the skin, usually behind the glans, they should consider removal. It is my impression that the device will not last over time, either because it erodes, gets infected or breaks apart, but in general, I do not remove the device in men who are happy with it.

(ii) If I'm having issues with the implant, what are the nature and severity of complications that would warrant a medically-necessary removal?

There are a variety of reasons to medically remove the device. They are as follows: erosion through the skin, infection, seroma (this is a fluid accumulation around the implant), breakdown of the device, pain, difficulty having intercourse and erectile dysfunction.

(iii) Are there any drawbacks for removing the implant, regardless of the reason I'm having it removed?

Every operation has risks. Removal of the device may cause internal scarring that can cause loss of length. There may be loss of skin of the shaft due to thinning of the skin because of the device. There may be loss of sensation from the action of the device on the shaft skin or due to injury to the nerve to the glans from the patch that is used to fixate the implant in the penis.

(iv) Is it true I could lose length after implant removal, and if so, what can be done to mitigate length loss?

Yes this is true. I will often perform ligament release at the time of implant removal or corrective surgery. Patients also need to wear a weighted condom after surgery for six months for six hours a day to maintain the length.

(1b) Dear Dr. Solomon, Forum Moderator Hoddle10 asks: "What do you consider the ideal patient? What makes someone a good candidate for penis enlargement surgery? Are there instances you'd consider turning away a patient?"

Let me answer the last question first. I turn away almost one third of the men who seek my opinion. Most often, these are men who are either very unrealistic in their goals, or they have a very normal to large penis and I do not think the benefit of surgery outweighs the risks involved. The ideal candidate is a healthy male who wants to make his penis larger in one or more dimensions and has no issues with erectile dysfunction. The reality is that I see men of all types with variation in their health, so I do make exceptions for different medical conditions. I do not do girth procedures on smokers. I have found that smokers in particular have a high complication rate from girth procedures, so I will no longer treat them. The corollary of that is that men who have complications of fillers and are smokers are also at high risk of complications. I ask them to stop smoking for 3 weeks prior to surgery and 3 months after surgery. I have had men who start smoking after surgery and inevitably they need more surgery to get them healed.

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