Penis girth augmentation using SEPA flap and dermofat grafts

Men of various ages feel that an increase in penile size would give them and their sexual partners an increased confidence. There are a variety of methods for increasing penile girth, such as injection therapies and surgery. All of these methods have a high complication rate which must be emphasized to the patients. In this article, the techniques used for increasing penile girth using dermofat grafts and SEPA (superior external pudendal artery) flaps are highlighted along with their complications and their management thereof. Ten patients were operated for penile girth augmentation between June 2016 and March 2022. Of these, six patients had augmentation using dermofat grafts and four patients had SEPA flaps. Patients were chosen as per the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory (APPSSI) score which was between 2 and 6 in the pre-operative period. The age range of the patients were between 25 and 57 years. The mid-penile girth in the flaccid state ranged from 8.8 to 12.3 cm. Post-operatively, after 6 months, the final girth increase varied from 1.9 to 2.6 cm. The complication rate was 50% and included skin loss, urinary obstruction, fat necrosis, and so on. The post-operative APPSSI score ranged from 2 to 12. Complications were more in uncircumcised patients and in those who desired excessive augmentation. Penis girth augmentation using SEPA flaps and dermofat grafts is indicated in patients who fulfill the criteria and give appreciable girth increase, but patients need to be aware of the potential complications of these surgeries.