Is there still a place for phalloplasty in 2008?

Penis lengthening and widening procedures still have a far greater place in the media than in the practices of urologists, sexologists or plastic surgeons. Even though plastic reconstructive surgery is currently extremely popular, the techniques remain confidential as few doctors, even specialists, are familiar with them and results are still unpredictable, even today. This article provides an overview of the technical aspects of lengthening or widening the penis, current results and future possibilities. Introduction: Still a controversial issue in 2008. Men have always thought their penis to be too small and possibly today more so than ever, as it is something discussed more and more frequently in the media. Psychological anatomical assessment is still subject to debate, with no general consensus amongst scientists. Possible indications: Although phalloplasty is sometimes a result of actual penile hypoplasia (congenital or acquired), it is more often a question of penile dysmorphophobia syndrome. We do not currently have an abacus or psychologically endorsed questionnaire available. Surgical technique: 1) Lengthening: the most usual procedure still involves section of the suspensory ligament from above and VY plasty; 2) Widening: injection of autologous fat is still the most common method, although new techniques are currently being developed (hyaluronic acid injections, fat grafts, biosynthesis, etc.). Assessment of results: There is still a chronic shortage of scientific, large-scale studies with long-term monitoring. This is mainly due to a lack of compliance and current results available are contradictory. Conclusions: There is currently no consensus regarding the treatment of penile dysmorphophobia and surgical treatment of the syndrome is relatively rare in France. The surgical techniques involved are never simple or risk-free, making most doctors extremely cautious in this respect. If treatment of this issue, still a knotty problem even in 2008, is to improve, studies on a much larger scale and with much longer psychological monitoring will need to be carried out.