Best Penis Enlargement Surgery

Penis Enlargement Surgery by Sava Perovic: Safer, Faster, Better, Permanent

prices | how to schedule surgery

Penis enlargement & penis size is of great interest to many people. Penis enlargement surgery by Sava Perovic has made male penis enlargment safer, faster and better. He does NOT use Free Fat Transfer (FFT) nor AlloDerm^® dermal tissue grafts, both of which Dr Perovic considers very inadvisable.

Sava Perovic penis enlargement surgery enables you to change your normal penis size. Penile surgery by Professor Dr Perovic doesn't result in the largest penis in the world but it does allow penile enlargement of the average penis.

It's among the most effective and best penis enlargement phalloplasty. As the international, multi-hospital study of 204 men over five years showed, the aesthetic and functional results of Dr Perovic's autologous ex-vivo tissue engineering for penile girth enhancement are excellent.

It contains many penis enlargement facts with a number of penis enlargement pictures, including penis enlargement before and after as well as measurable penis enlargement results. Does penis enlargement work? It answers that and other questions about surgical penis enlargement, especially whether penile enlargement surgery is the best penis enlargement choice when considering how to enlarge your penis. And it shows how the wrong penis enlargement technique can cause severe deformity of male genitalia.

Opt for safe penis enlargement plastic surgery by one of the world's best urologists and phalloplasty surgeons: SV Perovic. We charge nothing to coordinate your surgery by Dr Sava Perovic in Germany, Greece, Italy, Switzerland, Serbia or Thailand.

Penile "enlargement" includes both the lengthening and widening procedures. In most of the cases, Dr Perovic uses ligamentolysis for penile lengthening which results in penile lengthening in flaccid state. In obese patients, he does “wet” liposuction of the pubic region, as well as penile skin reconstruction where indicated in order to expose and in that way lengthen the penis in flaccid state. Autologous tissue culture is used for only penile widening, not lengthening. The results are permanent.

Currently in the world, there is no good and reliable technique for glans enhancement.

Years ago, tissue needed to be collected from the scrotum and grown for 3-5 weeks prior to surgery. Dr Perovic uses a much newer and better technique that get equally good results. It requires no tissue culturing in a laboratory, only implantation of the PLGA scaffolds treated in the patient’s serum.

The patient comes one day before surgery to give 100 ml of blood for the process.

Dr Perovic has done more then 300 cases of penile enlargement using PLGA scaffolds and the technique described on our site. Any complications are minor and all are treated without the need for more surgery. Dr Perovic takes responsibility for any post-operative complications that occur in about 3% of patients.

Patients that get liposuction need to remain 5-6 days in the city where the surgery is done but only 2-3 days if no liposuction is done.

Penile "enlargement" in Belgrade, Serbia is the most affordable of any location and is a package price that includes the scaffolds which are €1000 of the total. "Enlargement" includes BOTH widening (girth enhancement) using autologous tissue culture AND lenghthening using ligamentolysis. Standard procedure is full enhancement using both procedures. Only girth enhancement can be done for €1000 less than both.

In overweight patients, the professor also does liposuction of the pubic region as well as penile skin reconstruction, where indicated, in order to expose and lengthen the penis in flaccid state. This fee compares favorably with the fees of other surgeons using significantly less effective and much riskier procedures but charging US$9,850 to US$11,350 and in some cases up to US$15,000 with disasterous results and no remedy despite being done in the USA by a very well-known surgeon with excellent marketing. More detailed information about the professor's surgical fees are available on our price list.

One US dollar has about 70% the value of a Euro. One Euro equals about US$1.42.

Patients who want surgery should submit photos of their penis in flaccid and erect states also penile measurements of current length and girth.

This price is only for surgery in Belgrade. Surgery in other cities and countries is possible, such as Bangkok, but patients must then also bear the cost of Dr Perovic's travel expenses and accommodations. In cases where several various surgeries can be scheduled at the same location, those expenses can be shared among all patients. The doctor's expenses in other countries range from €2000-€2750 and you must also pay the cost of the private hospital.

In other words, if you don't want to wait until several patients can be organized to all have their surgeries done by Dr Perovic in Bangkok at the same time, then you need to get the surgery in Belgrade.

Surgery in locations other than Belgrade, Serbia, requires you to be flexible about your schedule since several other people also have to adjust their schedules so you can all be in the same country at the same time. It's not that difficult but takes quite a bit of coordination.

The professor's surgical fee is quoted in our response to a patient's submission of: 1) his/her medical history; and 2) a request to schedule surgery; and 3) photos when relevant, such as in all cases of penis enhancement or other biological male genital modification.

Patients that find Dr Perovic's fees a challenge to afford should note that no Thai doctors perform the professor's surgical techniques and do NOT do the exact same things in the exact same way and therefore do not share his extremely high rates of success and amazingly low rates of complications. (*See important comment from Dr Perovic.)

Tissue Engineering with Biodegradable Scaffolds

This news report for non-medical persons is a review of the international penis enlargement surgery study by Sava Perovic (SV Perovic) and others published in "European Urology" Volume 49 (2006), pp 139-147. Highlights include:

• 81% of patients scored the surgical intervention as ‘‘excellent’’ and ‘‘very good’’;
• 1.9 to 4.1 cm increase in penis girth;
• up to 4 cm increase for majority of patients;
• 71% of patients satisfied with new erect penile girth;
• penile enlargement surgery caused no penile shortening;
• autologous tissue engineering used biodegradable scaffolds;
• can be repeated after one year to gain additional girth;
• 29.8% of patients had previously failed penis enlargement attempts by other doctors;
• only 40–95 minutes of surgery;
• short hospital stay (average = 2.11 days);
• erectile function and penile sensitivity undiminished by enlargement;
• patients resumed sexual activity 4–6 weeks after surgery;
• autologous tissue engineering allows uncircumcised patients to keep their foreskin intact;
• remarkable safety, reproducibility, superior cosmetic results, low morbidity and low incidence of post-operative complications; and
• infections developed in only 3.6% of patients, all treatable.

Introduction

Following the increased popularity of female cosmetic surgery, genital modification surgery has successfully evolved during the past decade. Simultaneously, penile lengthening and widening gained tremendous interest in male population all around the world. Considerable improvement of penile aesthetic appearance and size is now possible although this surgery remains a challenge requiring strict attention to details and meticulous techniques.

The most common method previously employed for penile girth extension was lipofilling but with disappointing outcomes. True enlargement of the corporeal body could be achieved by autologous tunica albuginea grafting with a saphenous vein. Wrapping the penile circumference outside Buck’s fascia with autologous dermal-fat grafts to obtain gain in penile girth was also reported. Possible complications included temporary or permanent penile shortening, penile deformities, graft lost and unsightly donor site scars. Synthetic materials like injectable materials (hydrogel) were used with moderate results.

The study evaluated indications, feasibility, operating time, aesthetic and functional results and complications of autologous ex-vivo tissue engineering for penile girth enhancement (PGE).

Patients and Indications

Of the 204 patients who obtained penile girth enhancement from July 1999 to January 2004 from the Yeonsei-Plus Urologic Clinic in Seoul, the Presidential Hospital of Russia in Moscow and the University Hospital in Belgrade, 84 men ranging in age from 20 to 50 years (average age 28 years) were randomly selected to participate in the study.

Among those selected, 70.24% suffered penile dysmorphic disorder (preoccupation with an imagined problem in penile appearance) while 25 patients (29.76%) had a history of previously failed penile girth enlargement. Exclusion criteria were: a) history of previous psychiatric morbidity; b) organic diseases (e.g.; long-lasting, insulin-dependent Diabetes Mellitus and generalized atherosclerosis); and c) age less than 18 years.

Physical measurements of penile length and mid-shaft penile circumference in both the flaccid and erect states were obtained and recorded pre and post-operatively. Pre-operative and post-operative intracavernous injection of Prostaglandine E1 and Doppler ultrasound were used for assessment of erectile function.

Cell Harvest Method

After local infiltration of 1% of lidocaine solution, a thumbnail sized, elliptical shaped skin incision was made and 0.5–1.0 cm³ of dermal tissue was harvested. Biopsied dermal tissue was washed to remove red blood cells in serum-free Dulbecco’s modified eagle’s medium and minced into less then 1 mm pieces which were then distributed over three 100 x 15 mm Petri dishes.

The sliced tissues were treated with collagenase type IV, (2 mg/ml) and incubated at 37.8°C with 5% carbon dioxide for 24 hours. Fibroblasts were suspended in culture media containing 5% of the patient’s serum and expanded in culture until the total cell number of at least 2 x 10⁷ was reached. The time required was between three and five weeks depending upon individual patients (mean 27 days).

Scaffold Pre-Treatment and Cell Seeding

Dry polylacti-co-glycolic acid scaffold (PLGA) 50 mm in length, 30 mm in inner diameter and 3 mm in thickness, pore size 250 to 400 mm, was hydrated by complete immersion into 75% ethanol solution in aseptic condition and kept in a refrigerator (4°C) overnight.

The ethanol solution was removed completely by repeated washing with sterile, pyrogen-free cold water, phosphate-buffered saline solution (Ca, Mg-free, pH 7.0) and serum-free culture medium. Pretreated scaffolds were then seeded with approximately 20 million fibroblasts and incubated for 24 hours at 37°C.

Implantation

Prophylactic antibiotic administration was systematically prescribed 24 hours before surgery. After subcoronal incision and penile degloving, two cell-seeded scaffolds were shape adjusted and transplanted between dartos and Buck’s fascia. When the skin was non-compliant, scaffolds were placed under the lifted neurovascular bundle.

A ventral longitudinal incision with penile eversion and degloving was used in patients who requested prepuce (foreskin) preservation. Penile skin reconstruction followed repair of dartos fascia. A compressive dressing was left in place for 7–10 days. Antibiotics were administrated for the next five days.

Two weeks after surgery, patients started to use a vacuum device twice a day (5–10 minutes) during the first six months to prevent temporary penile retraction. The clinical data concerning the final outcome and complications were obtained and recorded on control visits at two weeks as well as at 1, 3, 6 & 12 months after surgery and then annually.

Instruments

A study instrument comprised of a short, structured questionnaire, was modified and adopted from a validated study for a long-term outcome evaluation in hypospadias surgery. Answer options ranged from ‘‘dissatisfied’’ and ‘‘somewhat satisfied’’ to ‘‘completely satisfied’’. Surgery was also judged on a scale from 1 to 5 with 5 being the best. A genital appraisal was assessed in the second part of the questionnaire.

Possible answer options for the patients-rated satisfaction with flaccid and erect penile girth were ‘‘satisfied’’ or ‘‘dissatisfied’’ while scores for satisfaction with general penile appearance ranged from 1 to 5 on the following scale:

• 1 = very dissatisfactory;
• 2 = dissatisfactory;
• 3 = good;
• 4 = very good; and
• 5 = excellent.

Data analysis was done using Students t-test (t-test for dependent samples), the X² test with Yets correction (Yates corrected Chi-square). A p value of 0.5, 0.01 and 0.001 were considered statistically significant.

Results

Of the 204 men operated, 84 patients with a mean age of 28.77 (±6.61 at the last control) were randomly selected to participate in the study. Participating subjects did not differ significantly from non-responders regarding indications for surgery, mean age at the present study, mean number of operations and immediate post-operative complications so the sample was assumed representative.

Anesthesia was general in 16 patients (20.12%), spinal cord in 25 patients (49.40%), epidural in 31 patients (36.90%) and local in 12 patients (20.48%).

Of 59 patients (70.24%) with penile dysmorphic disorder, 44 patients (52.38%) underwent primary penile enlargement while 15 men (17.86%) underwent combined release of penile ligaments (lengthening) and girth enlargement.

In 25 patients, penile girth enlargement was performed after previously failed attempts.

In 81.93% of cases, scaffolds were placed between dartos and Buck’s fascia. In 18.07% of cases with noncompliant penile skin, scaffolds were placed under a previously dissected neurovascular bundle.

The average length of surgery was 60.77 minutes (±18.44) and ranged from 40 to 95 minutes. It was significantly better for the patients with primary penile girth enhancement at 43.91 minutes (±2.40) compared to those men with previous surgery and combined penile girth enhancement and release of ligaments 80.84 minutes (±5.14) and 76.80 minutes (±8.06), respectively (p < 0.001).

Post­operatively, partial pressure necrosis (the death of living cells or tissues) of the skin occurred in two patients with a history of previous surgery. It was treated conservatively.

Temporary seroma (mass or swelling caused by localized accumulation of serum within tissue or organ) occurred in six patients who had sexual intercourse earlier then advised (six weeks after surgery) and was treated successfully by repeated evacuations.

Wound infections were identified in two patients and resolved after two weeks with local treatment.

Mean hospital stay for the patients with primary penile girth enhancement and combined penile girth enhancement and release of ligaments (lengthening) was 1.82 days (±0.45 days, range 1-3) and 1.53 days (±0.52 days, range 1-2) days, respectively. For the patients with a previous enlargement surgery mean hospital stay was 2.96 days (±1.06, range 1-5), significantly longer then for the other two groups (p < 0.001).

Mean follow-up was 24.67 months and ranged from 1 to 5 years.

In total, mean value of flaccid and erect girth gain was 3.15 cm (±0.42, range 1.9-4.1 cm) and 2.47 cm (±0.49, range 1.8–3.0) respectively. In the group with combined penile girth enhancement and release of ligaments (penis lengthening), mean value of flaccid and erect length gain was 3.45 cm (±0.52, range 2.1-4.5) and 0.65 cm (±0.32, range 0.5-1.0), respectively.

Among the different groups, the best results were encountered in the group for primary penile girth enhancement, with a mean flaccid girth gain of 3.35 cm (±0.31, range 2.3–4.1), compared to those with a history of previous surgery and combined penile girth enhancement and release of ligaments 2.78 cm (±0.24, range 1.9–3.4) and 3.17 cm (±0.53, range 2.5–4.1), respectively.

Erectile function and penile sensitivity were not changed after surgery since there were no intraoperative damaging of the dorsal neurovascular bundle or other penile structures.

Genital Appraisal

Only one patient judged general penile appearance as dissatisfactory, giving a mark of "2" while mean self-rated genital appraisal was 4.07 (±0.71).

Among the subjects in different groups, patients with a history of previous surgery tended to score genital appearance lower (3.88, +0.60) compared to those with primary penile girth enhancement (4.20, ±0.76) and penile girth enhancement and release of ligaments (4.00, ±0.65), but without statistically significant differences.

Participants in all groups were mostly satisfied with penile girth in flaccid and erect state (63 and 71%, respectively) without significant differences between the groups.

Urologist-rated satisfaction with the flaccid and erect penile girth was slightly higher, given that they were satisfied with mentioned parameters in 67 and 73% of cases, respectively.

Satisfaction with Surgical Results

Subjects who had undergone penile girth enhancement after previous failed attempts, scored surgical intervention slightly lower (4.04, +0.79). However, this difference was not statistically significant. In total, participating subjects appraised the surgical intervention as follows:

• 44.53% gave the surgery a "5";
• 36.90% gave the surgery a "4"; and
• 19.05% gave the surgery a "3".

When answer options ranged from ‘‘dissatisfied’’ and ‘‘somewhat satisfied’’ to ‘‘completely satisfied’’, then 70% said that they were ‘‘completely satisfied’’.

Urologist-rated satisfaction with surgical intervention was ‘‘completely satisfied’’ in 73% of cases. Finally, only two (2.38%) patients wanted further surgical revision to improve accomplished results.

Summary

There are still ethical and medical dilemmas without uniform indication for penile enhancement surgery. The operative techniques and assessment of the results are currently not standardized in medical literature with reports claiming exceedingly better results then generally possible.

Several reports advocated different methods for penile girth enhancement. Beside autologous lipofilling as the method most commonly employed, autologous dermal-fat grafting was also reported. Possible complications in this treatment option include graft lost, unsightly donor-site scar, temporary or permanent penile shortening and penile deformities.

A critical assessment of previous reports in medical literature points out that reported disappointing results were mainly a consequence of the post-operative fat re-absorption. To reduce the chance of post-operative fat re-absorption, Asaadi and Haramis recommended irrigating the fat with a solution of 100 U of regular insulin to stabilize lipocyte membrane.

Yukel investigated recently the local effect of insulin and growth factors on free fat graft survival. He found that long-term local delivery of growth factors have potential to increase fat graft survival.

Ayhan reported positive effect of ß–blockers in increasing free fat graft survival in an animal study. However, a report by Chajchir showed no beneficial effect of insulin or centrifugation on adypocyte survival during their transplantation.

Tissue engineering in penile enhancement surgery is a new approach to fabricate a new functional tissue from autologous cells and consequent penile girth augmentation. In the Perovic study, they applied a principle of transplanting autologous cells onto a biodegradable scaffold that provided appropriate mechanical strength to induce three-dimensional growth of a new functional, autologous tissue. They hypothesized that expanded cells harvested from the scrotum could migrate into the biodegradable and biocompatible scaffold, would form viable tissue and would start its degradation to support the growth of a completely normal tissue without inflammation.

Dr Perovic and the other urologists used macroporous, biodegradable PLGA (poly­lacti-co-glycolic acid) scaffolds whose porosity ranged between 85 and 90%. Average pore dimension was between 250 to 400 mm which is adequate for migration and growth of fibroblasts who were naturally selected during the cell proliferation period and whose diameter was about 10–15 mm.

Earlier studies with non-woven mesh scaffolds have found that pore size, pore orientation, fiber structure and fiber diameter can influence cell behavior and tissue development. The pores of PLGA scaffolds are interconnected to each other which provides adequate communication of growth factors, nutrients and oxygen as well as seeded cells migration and intracellular matrix and vascular regeneration. The biocompatibility and degradive properties of PLGA scaffold were excellent and this finding confirms previous reports.

The degradation rate ranged from 6 to 16 weeks after pre-treatment with 75% ethanol. Histological examination six months after intervention demonstrated newly generated tissue which appeared viable with significant cell number, collagen content and in­growth of capillaries.

The clinical experience with this new treatment approach for penile girth enhancement showed its remarkable safety, reproducibility, superior cosmetic results, low morbidity and low incidence of postoperative complications compared to previously established procedures.

The possibility of performing this procedure under local anesthesia and with a short hospital stay (mean 2.11 days) are the points in favor for the low cost-effectiveness of this approach.

Mean operative time was approximately one hour and final surgical outcome concerning penile girth gain was almost 3 cm. Erectile dysfunction or sensitivity deficiencies were not reported in immediate postoperative period nor later.

Except for the patients with seroma formation, all patients resumed their sexual activity 4–6 weeks after surgical intervention.

Previous surgery often limits the availability of compliant skin. Extensive dissection and placement of the scaffold under the lifted neurovascular bundle provides the most favorable conditions for successful outcome in these cases.

The only good functional results available to assess objectively delayed final outcome of penile enhancement surgery (including patient satisfaction with the achieved surgical results) is the series by Austoni. He reported true increase in volume of the corpora cavernosa by bilateral saphenous grafting of tunica albuginea with excellent patient satisfaction and no complications. However, this technique enables penile girth augmentation only in erect penis with reported postoperative increase in diameter that ranged from 1.1 to 2.1 cm. In the Perovic study, minimal flaccid girth gain encountered was 1.9 cm and ranged up to 4 cm for the majority of patients, even in the group with previous surgery.

To address this controversy in the outcome, the present data showed no association between penile enlargement surgery and penile shortening. Importantly, in the cases of combined penile girth enlargement and release of ligaments, placement of the scaffold proved to be suitable to prevent ligament reattachment and consequent penile shortening.

Penopubic ligamentolysis provides apparent but not real lengthening since penile structures remain unchanged. Thus, any gain in penile length is noticeable in flaccid state but minimal in erect state.

A vacuum device was advocated 5–10 minutes twice a day due to the tendency for temporary penile retraction during scaffold degradation, which occurs one to three months postoperatively. Thus, there were no cases of permanent penile retraction. Consequently, this technique could be most reliably applied for successful penile girth augmentation even after previously failed attempts.

Moreover, this technique can be repeated also one year after primary enlargement in order to gain additional girth. In some patients, new procedure to increase girth gain is required as a consequence of penile dysmorphic disorder.

More then two thirds of 84 patients, claimed to be completely satisfied with achieved surgical results while almost 80% of patients scored surgical intervention as “excellent” and “very good” (44.05 and 36.90%, respectively). There was also high level of agreement between the patients and surgeons about satisfaction with the accomplished results.

In total, mean value of self-scored genital appraisal was “very good” while two-third of patients were satisfied with penile girth in flaccid and erect state (63.09 and 69.09%, respectively). Dr Sava Perovic's approach is a straightforward and useful method to reduce the negative psychological impact of low genital appraisal among certain segments of the male population worldwide.

Although the scaffold consisted of biodegradable synthetic polymer, possible limitations of this concept could be the absence of biologic recognition. As an approach toward the incorporation of cell-recognition domains into these materials, copolymers with amino acids have been synthesized. Other biodegradable synthetic polymers, including poly (anhydrides) and poly (orthoesters), can also be used to fabricate scaffolds for genitourinary-tissue engineering with controlled properties. However, taken together, this approach represents potentially important improvement in the field of genital reconstructive surgery.

Conclusion

Autologous tissue engineering using biodegradable scaffolds as a carrier is a proven and safe therapeutic approach for penile girth enhancement. This procedure shows significantly lower complication rate then previously established procedures. Other advantages are simplicity, low morbidity (incidence of ill health), reduced operative time and bigger penises.

This news report for non-medical persons is a review of penis enlargement research by Sava Perovic (SV Perovic) and others published in “European Urology”, Volume 49, Issue 1, Sexual Medicine section, pp 139-147, January 2006: “New Perspectives of Penile Enhancement Surgery: Tissue Engineering with Biodegradable Scaffolds”

Find answers to many questions Dr Perovic has been asked in our Frequently Asked Questions (FAQ) page.

Scheduling Penis Enhancement Surgery by Dr Perovic

Scheduling surgery is simple. Provide Dr Perovic with your medical history and photos of your penis in both flaccid and erect state. Along with your medical history, request the specific procedure you want and the exact day you prefer to get it. Professor Perovic will respond with confirmation of the date or will suggest the next available date closest to that one. Patients report that there are certain periods when flights to Serbia are steeply discounted. Visits to Belgrade by patients are well organized and more affordable than any other locations.

The doctor's fee includes everything related to the surgery except extra food not provided by the hospital and any activities not related to the surgery. You will be picked up at the airport by a member of Dr Perovic's team and returned to the airport when you are ready to return home. There is no charge for the medical facility. Penis enlargement patients do NOT need to rent a hotel. You can stay at the hospital or clinic your entire visit. A companion can also stay with you for Euros 50 per day. Some patients carry cash, others make arrangements with their bank to withdraw the money in Belgrade the day before the surgery.

You can submit your Medical History directly to Dr Perovic. You will also need to send him as email attachments some original size, flash (or with good light levels), digital photos of your penis from left right and center in both flaccid and erect states.

Use a good camera rather than a phone to shoot the photos if possible. No need to crop or edit the photos in any way. The photos will be prepared for optimum viewing by the professor. Try to make your penis fill as much of the viewing area of the camera as possible but do NOT get so close that the photos become blurry. Most cameras require the subject to be at least one meter away from the camera.

For post-op procedures following penis enhancement surgery, read here. Regarding the number of surgeries he has performed read here.

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