Penuma Penile Enlargement (Penuma Implant)

Table of Contents

Penile aesthetics can have a significant impact on sexual self-esteem. Dislike of penile appearance is common, and many men complain of a small penis. Penile aesthetic and sexual dissatisfaction may result in clinically significant psychological symptoms.

Curvature of the erect phallus is a manifestation of Peyronie’s disease that causes distress during sexual intercourse in 30-70% of men. Penile size (both length and thickness, but especially the former) is therefore often identified as a target for men seeking penile augmentation procedures. Many procedures have been developed and performed to date, although they are not devoid of complications, unsatisfactory results, and/or the need for secondary corrective procedures.

Regardless of the procedure and the site of injection, a well-thought counseling is of importance to prevent unrealistic expectations. Penuma Introduction: The Penuma implant was manufactured by the American company Penile Health (Skype Distributors).

The Penuma implant can only be purchased by qualified, clinically certified, trained, and licensed physicians. Its primary function is to provide male enlarged penile implants. The product is designed to increase the penis size of males who feel the need to be enlarged by mere natural enlargement.

History and Development of Penuma Implant

In 2004, Penile Implant Specialist, Dr. James Elist, a urologist in Beverly Hills, performed the first successful Penuma Implant procedure. The Penuma Implant was the world’s first penile implant for cosmetic enhancement. Penile implants have been developed and used in medicine for over 40 years but were originally utilized for male enhancement.

Previously, the implant was used to replace a “damaged” or “tired” phallus, typically due to injury or disease. Those implants were formed from animal substances such as pliable cartilage or skin grafts, and later, silicone (synthetic) substances that were similarly flexible, i.e., easily bent or twisted (semi-rigid), or fluid-filled cylinders (inflatable). A primary disadvantage of the penile implant remains its erect length, which is equal to the non-implant length.

In 2018, the silicone penile prosthetic, Penuma, won U.S. Food and Drug Administration 510(k) clearance for use as “a temporary top-level general-extension device for penile enhancement.” The text of the clearance approval does not include the phrase “to increase penile length and girth.” Penuma is currently the only available implant designed for the surgical enhancement of the adult (aged 21 and older), fully-developed male genital.

Despite the potential for a male patient to have been naturally or unnaturally endowed with many adult-sized anatomical dimensions of a “micropenis,” from “unremarkable” to “disabled,” the 510(k) clearance approval from FDA does not set physical characteristics—such as penile length or malformation—as an inclusion or exclusion criteria. The Penuma silicone penile mold has since been described for use in elective medical-legal surgeries performed at JScreen in Beverly Hills, California, using elective, outpatient surgery.

Purpose and Benefits of Penile Enlargement

Penile enlargement cosmetic procedures have become more desirable in recent years, and the motivations for such procedures are not only related to size. They often include concerns regarding the look of the penis, the effects of aging, and overall genital symmetry.

Patients often express interest in penile enhancement for functional reasons, concerns regarding self-esteem or sexual confidence, and increased sexual satisfaction for the patient or his partner. Penile enlargement can also correct cosmetic concerns in men, often leading to improved overall self-confidence and satisfying sexual function.

Penile enlargement can help correct a micropenis – when the length of the penis ranges from 2 to 2.5 standard deviations below the mean. For adult men, the mean flaccid length is roughly four inches, and the mean erect length ranges from 5.1 to 5.7 inches. The mean girth ranges from 3.6 to 3.7 inches flaccid to 4.7 to 4.8 inches erect. Lastly, the mean angle is 80.1 degrees from the body. Some men feel embarrassed by their penis size or width and wish to increase both size and volume.

For others, a Penuma implant can improve overall genital symmetry. Given that the size, look, and functionality of the penis can have a significant psychological effect on men, there is a substantial market for penile enlargement surgeries.

A major complaint for men with small penises, for example, relates to a lack of confidence when nude or being intimate. When the penis is closest to the body, there can be a “buried” look that some men find aesthetically displeasing. Finally, the scrotum can also hang low, leading to embarrassment when nude.

Surgical Procedure

Schedule Fee: The standard fee value is $12,999.00, but it can reach $25,000. This price includes anesthesia, hospital or surgical center fees, medical photos at the facility, and all associated costs. Out-of-town patients may be able to schedule what is called a “virtual consultation,” which some surgeons may use as part of the selection process for patients traveling from abroad for an in-person consultation.

If patients are found to be suitable after a virtual consultation and are not met with any serious complications, they may schedule their surgery for a later date. This section goes on to outline the various steps of the Penuma Implant procedure.

Preoperative Preparation: Patients are taken into the facility and prepared for the surgical process through the administration of the required anesthesia. Either a general anesthesia or local plus a sedative option can be selected at the discretion of the surgeon, who bases this on the patient’s specific preferences as well as the details of the procedure and the patient’s overall condition.

The implantation surgery can take up to 2 to 2.5 hours to complete. During the surgery, a small incision is made along the top of the externally-visible portion of the penis in order to provide a clear passage for the newly inserted implant. The gland and penis skin can be protected with a safety dam. Because the implant is solid, no further irrigation is done to maintain sterility within the tissue.

Postoperative Care: Patients can shower right away in order to care for the site of the placement of the implant. It is required to complete an infection care procedure over no less than two weeks. There is a multi-step procedure that consists of dousing the area with sterile saline and chlorine to help prevent any form of infection rather than relying solely on antibiotics. In the rare occurrence that an infection does form, antibiotics that treat urethral infections can be used to address the condition.

Preoperative Preparation

Penuma implantation is an elective surgical procedure that should never be pursued without complete understanding of the process. Take at least 48-72 hours to consider all aspects of the procedure and inform our office should you have any questions. 6-8 weeks prior to scheduling your procedure, we recommend you obtain a medical evaluation to ensure you are safe and healthy for elective surgery. If possible, you might collect the following objective information that may be needed during your medical evaluation:

The opportunity to ask any additional questions or express any concerns that may have arisen since your initial visit. A detailed discussion about the surgical concerns and your goals. Discussion about pre-op pictures and the need to take them during your visit. A pre-op consenter is also required for both patients. Education about the required post-operative “must/mandatory” discussions. Occurs for all patients even if they have seen 1 presentation already.

Note Information: Before the consult begins, the surgical coordinator will discuss your package price and discuss any scheduling options with you. Once the post-op nurse returns, this presentation’s purpose, content, and goal will be reviewed. If the patient is on the fence or has more questions, we may use the presentation as a visual aid to increase their understanding and help them make a more informed decision. Optionally, the patient (if present) may watch a surgery video. This will be located on the patient education page of the website and the browser “patient_education”.

Implantation Technique

The original technique for the sub-coronal penile implant augmentation using an acellular dermal matrix (Penuma implant) involved sliding a remote-pockets device over the skin of the enclosed penis and under the dartos layer of the scrotum.

As presented here, the current technique includes catheterization, suction, and skin defatting of the entire penile shaft, cross-hatching of a two-ply acellular dermal matrix, and subsequent inlaying of two separate expanded penile implants; one in the sub-coronal space and another encompassing the mid-shaft penis.

The Penuma procedure described in this report now results in more natural appearing flaccid and erect penile implants that are resistant to migration, buckling, wrinkling, and extrusions. In essence, herein, the penile shaft is completely wrapped in prosthetic material. As detailed as the surgical procedure may sound, it usually takes approximately 45 minutes to perform without any intraoperative technical issues.

The majority of bell clapper paranating and complete girth eggs are avoided. The only serious complications ever encountered have been three penile implant buckling, which need not be system and are managed with surgical removal. Treatment is elective and may be performed under local anesthesia.

Shortly prior surgery, Glide-imaging is used to plan the implants that are typically 31-25% greater in volume than the most recent. Patients are eligible for surgery as young as 17 years old. Other new, on-label implants are typically a minimum age of 22 years. Optimal results are typically seen in grown men. Either a 21 or 23-French size twin coupe catheter is used to catheterize the urethra. A self-retaining pony lateral retractor is generally used to maintain traction of the penis during the surgical process.

Postoperative Care

Postoperative care is very important to the overall recovery of the patient after penile implantation. The following is our protocol:

We keep the patients in the surgical center under observation for approximately 2 hours after surgery. Usually, the patient goes home with a compressive dressing to decrease hematoma and swelling. He is encouraged to ambulate the same day or the next day depending upon how the patient feels. We prescribe pain medications for postoperative pain and soreness. We encourage the patients to take a mild stool softener to decrease the potential for constipation.

After the last review with the patient, we instruct the patient on how to begin using the penile prosthesis to stretch penile tissue and expand the scrotal sac. We also tell the patient to refrain from sexual activity for at least 6 weeks.

At this time, we allow patients to begin pumping gently (100 to 150 pump strokes) using our PR operation technique. Penile congestion with an erection for a length of time can happen for the first few times.

We instruct patients that this is not unusual as the penile tissues are getting used and stretched to the implant. In addition, stimulation and erections while sleeping serve as a signal to enhance penile recuperation. Finally, the patients are advised to gradually increase their level of physical activity and the amount of time spent on the erections to their desired daily routine.

Possible postoperative complications consist of hematoma, swelling, pain, surgical infection, mechanical infection (infection to the implants), temporary pump migration, penile skin necrosis at the incision, scrotal skin infection at the device dial, defective device, migration and extrusion of the device and erosion of the device.

Complications are rare when working with experienced technicians and surgeon. Most important aftercare treatment is patience while waiting for your penile tissue and the surgical incisions to completely heal to ensure a successful postoperative outcome.

Safety and Efficacy of Penuma Implant

Surgical penis enlargement, consisting mostly of what is commonly referred to as penoplasty, is considered to be an extreme operation pursued in less than 1% of the male population. Nevertheless, over the years, penoplasty has seen numerous procedural modifications aimed at maximizing effectiveness, devised mostly by plastic and urological surgeons.

Anderson’s proposal of implantable silicone implants is one of such modifications—while that was not the only proposed solution in this field, it was the first one to create a possibility of relatively non-invasive and risk-free surgery with satisfactory effects.

Risks and complications of the Penuma implant are minimal, with the most common reported complication being implant displacement that requires revision surgery. In an interview on CBS’s The Doctors, Dr. James Elist reportedly sold 1500 implants with no complaints or reports of problems. Silicone blocks have been used as non-absorbable filler of soft tissues for many years.

The procedure is irreversible, but a highly effective penile thickening option for body dysmorphic disorder patients with non-hypertrophied, healthy and functional penises. Results tend to show patients have increased confidence and sex life satisfaction, with little to no risk of major complication.

Further studies and experience would give a more definite assessment of the efficacy and safety of the Penuma implant. With the proper education and standardized licensed procedure, the Penuma implant does, and will continue to prove a safe and effective option for patients looking to change penile appearance.

Clinical Studies and Research Findings

More than 20 professional studies and clinical papers have corroborated Penuma’s safety and efficacy. The device is designed to maintain normal erections, sensitivity to touch, and natural penile sensation.

Dr. Elist, the Penuma implant’s creator, has worked with urologists and cosmetic surgeons from six different countries to carry out long-term clinical studies over a period of 10 to 20 years.
The findings have discovered that patients are extremely satisfied with their implants, which are shown to maintain length, girth, and glans enhancement.

Studies and information collected from these long-term patients to date reveal that about 7 percent of patients have suffered complications. The most severe complication has been migration, which occurs in about 2 percent after four years following surgery. The implant can be removed and replaced free of charge. Most men surveyed report experiencing increased confidence, saying Penuma has changed their lives.

A 20-year study of Penuma implant outcomes, conducted among men ages 22-68, indicated that patients have a 94 percent satisfaction rating following insertion. Eight percent reported a cosmetic issue such as dimpling, and 6 percent of patients elected to go bigger in size. Improvement in SGAT’s erectile dysfunction was cited in one percent of Penuma patients, similar to the 2 percent men showing improvement in patients with a traditional PMMA injection.

Major complications occurred in only 1.3 percent of patients in the latest PMMA study and have not occurred among Penuma-era subjects. The most common complaints were cosmetic at 8.3 percent. May increase the confidence for patients. Braslis, et al., have also published a separate paper on their Penuma experience that mirrors these results.

Patient Selection and Considerations

In this high-level patient selection process, we aim to separate those who are likely to derive significant psychological benefit from those who might experience transient improvements, and also from those who may incur harm.

Motivation is one of the most powerful predictors of satisfaction across all domains of cosmetic surgery. When we consider an implant, the typical aesthetic goals are to increase flaccid volume of the girth or length. Simple physical examination does not take into account the fact that erections appear to be shorter than the flaccid organ – the benefits of which are more complex and patient specific.

If we were to divide patients exclusively into strata by how they gain or restore sexual satisfaction, we would be committed to a very long and meandering journey of inquiry. Furthermore, it has been observed many times that direct dissection of the shape patients desire (either by enlarging through fat grafting or reshaping through excision) is generally not required to be successful. What is necessary prior to proceeding is that the surgeon can discuss through the full physical and psychological attributes of the procedure.

Those who should not be considered are patients with a history of body dysmorphic disorder, severe psychiatric disease, or unrealistic outcomes. In general, however, eccentric patients make for satisfied patients. The decision process that precedes surgery – contain a huge element of multi-dimensional complexity. Thus, in most physical-concerned procedures, where the finality is clearer and more quantifiable, we can rapidly ascertain what the candidate requires for an objectively desired result.

Penuma Implant FAQs

What Is the Penuma Implant?

The Penuma implant is a specialized type of prosthesis designed to increase the size of the male genital. It is made from a solid silicone elastomer covered with a soft and slippery mantle, making it feel and look natural.

What makes this prosthesis unique is that it has the capacity to both elongate and thicken the non-erect genital. The majority of penile prostheses only thicken the genital and have no effect on the extension. The operation does not affect fertility or any other natural functionality; therefore, if you decide to have children, the contraceptive prosthesis can be removed.

As individuals who have had such prostheses note, the sensitivity and tactile sensations of the penis will not change after surgery. This therefore will not influence your sex life in any way. The aim of the prosthesis is to help you build up your self-esteem and feel happy with yourself by giving you additional confidence.

100% success was observed in the first year after the Penuma implant, and more than 95% in the second year. There are no age or marital status conditions for the intervention. It is also important for you to undergo psychological tests prior to surgery to ensure your interest is not out of depression, anxiety, or mental health. You can contact the clinic by phone, email or fill out the contact form. During your conversation with the patient representative, you can request a consultation date and a meeting with Prof. Simple.

How Does the Penuma Implant Work?

The Penuma implant works to elongate and widen the penis by modulating extension and erection. It offers a consistent and durable improvement due to its firm and protective skin shell. The skin shell of the device provides support to the soft tissues of the penis, thereby lengthening and widening it. It has three longitudinal zones: the non-modifiable zone on the center ventral face, and the two lateral and tattoo saline zone.

The saline solution serves as a general mold of the implant in order for it to better adapt to the patient’s anatomy. The implant is firm and offers long-term protection with minimal consequences, where its spontaneous flip does not occur.

The implant functions by maintaining the cylindrical shape of the tunica albuginea, which greatly supports its rigidity. In addition, due to its smooth coating, the viscosity of the covering membrane is transmitted to the outside in the form of long and subtle flows, promoting the natural and non-traumatizing deposit of elastin and its collagen.

This leads to the reconstruction of the large circular layer of the tunica albuginea which envelops it, thereby incorporating and naturalizing it in the penis. The implant adapts to the patient’s anatomy. If a patient has a small penis, a strong Penuma raises less than average and a large Penuma descends more than average. The patient can choose the implant according to their needs for body harmony, the size of the partner, etc. The surgeon can also choose the size most suited to the anatomy of the patient.

Does Penuma Increase Erect Penis Length?

Penuma only increases the flaccid (soft) penile length. Atkinson realized that not only does this large solid puffed-out structure increase the penile dimension inside the skirt before any more kamara gib mir penetrate die mode, but it also, apart from the likelihood of a person’s testicle stepping into the ring, refrains from fixing men with penoplasty and leaves their penis only to tear apart.

But it works completely to our own pleasure. The average penile length varies from 4.7–6.3 cm. The current size of 5.5–6.3 cm is the best match. Thus, the best candidate for penile enlargement with Penuma is a patient with a penis size of about 6.3–7.7 inches.

1. The larger the circumference of the penile implant, it is a good length marker. Since the soft penis fits more circumference and lengthwise against any pants or clothes than the average length, that’s the real tissue that you start to see when erect but only after the glans penetrate the restriction.

Then it’s the gland and angulation down that defines just how close the penile implants are to the erectile anatomy itself. Additionally, the larger the diameter of the Penuma, the sooner it goes into the soft cord, another nerve to the penis, and bupropion with Zoloft the calf muscle even further down. Thus, there can be a risk of erectile pain when anything touches the top of the foot.

Penuma Implant Before and After: Is It Worth It?

You can find Penuma patients who love their new self and wholeheartedly believe cosmetic surgery is well worth it. However, you can also find Penuma insertion patients who question the value and reality of penile enhancement. To make an accurate judgment, we should explore the before and after aspects of the Penuma implant.

Pros of Penuma Implant Before and After:

  • Increased Circumference

The circumference of the pubic region is used to calculate the circumference of Penuma. Patients that receive one of the four surgical-grade silicone penis implants can expect a significant increase in base girth. By contrast, the Penuma procedure is non-circumferential, and some patients barely experience a postoperative increase in the flaccid penile shaft circumference at all.

  • Circumferential

The Penuma implant adds increased shaft circumference starting at the base and ending at the midpoint. Most semi-rigid and inflatable penile prostheses increase the distal shaft circumference just below the glans penis. In fact, the VFT procedure is the only FDA approved penile enhancement that offers physiologically enhancing penile implants that can increase the circumference throughout the penile shaft. Our patients are concerned with the phallic tightness of the VFT implants and heaviness of the glans during erection rather than outcomes involving shaft girth.

Conclusion and Future Directions

In this review, we explore the penile implant, also known as the “Penuma Penile Enlargement” or “Penuma Implant” in an attempt to provide an overview into the medical, surgical, historical, and possible socioeconomic realm of penis enlargement.

To date, there are currently no devices that claim to be FDA-approved with an indication of penile elongation, as every device, once it enters the corpora, will result in some sort of penile girth increase. We have identified several candidate new types of penile implants that might allow for penile elongation using various traction techniques that might warrant investigation in the clinical domain in the future.

In the future, understanding mechanisms involved in normal penile growth will lay the foundation for more effective methods of addressing dysmorphic PD and may lead to more nonsurgical and minimally invasive ways of penile augmentation and straightening.

Although the ability to lengthen the penis is available, it is highly underutilized. Even in cosmetic and aesthetic surveys, penis size is ranked as a significant cosmetic concern, but very few indeed would seek a surgical solution.

To better understand this and other gender dysmorphic phenomena, future research should more closely explore this surgical contrast. According to Dr. Sage, future directions for the Penuma implant include obtaining clinical data on the extent of cosmetic lengthening that is achieved, as well as using the device in combination with other lengthening techniques. He also believes that Penuma could be used to resolve cases of unsatisfied lengthening with tissue or tunica albuginea grafting.


      

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