Impact of doctor on implant size?

The final frontier. Deciding when, if and how.

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Luther
Posts: 9
Joined: Tue Oct 22, 2019 8:50 am

Impact of doctor on implant size?

Postby Luther » Mon Feb 10, 2020 9:15 am

Dear FT members, I have three question:

1) Does the choice of surgeon has a great impact of the size of your implanted penis? Or is the difference between surgeons not as big, as long as it is an experienced "high volume" doctor?

I had a pre-surgery consult last week which worried me a bit. In the consult, the stretched state of my penis was about an inch shorter than my normal erect penis size (7 vs. 8 inches). When I addressed this, the doctor said not to worry, and that my penis would keep it's current size. I understand that the measurement of the corpora on the day of the surgery is more important than the stretch test. However, the doctor made a remark that my size "was more than adequate for sexual intercourse" and that men should not be so concerned with their penis size, which made me clear his emphasisis' was on functionality and certainly not upsizing.

2) I told the doctor that the glans of my penis often is not engorged. However, when I combine a cock ring with a PDE5-inhibitor I can get a full glans. The doctor told me I should not use a cock ring in combination with a penis implant as this may cause damage to the tubing (I know Perito in one of his video's actually recommends a ring for soft glans in men with an implant). I am therefore afraid that surgery will lead to an unsatisfactory result. The doctor said that sensation will likely be improved, even with a soft glans. Is this a good trade off: better erection (i.e. harder shaft) but softer glans?

3) What is the current consensus on best post-operative procedure for maintaining size? I read "we recommend leaving the implant inflated 60%–80% in the immediate postoperative setting for approximately 6 weeks", but I also read "during the first three months after the surgery the cylinders must be kept fully deflated in order to maintain the reservoir fully inflated. This will allow scar tissue to form on a full reservoir and prevent auto-inflation later on".

https://www.urologicalcare.com/penile-i ... nile-size/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6337945/

As this is my first post a little background information. European, almost 50 years of age. Athletic, good health. Ten years ago I was already diagnosed with organic E.D. (doppler and injection of Bimix). Injections do not do much. Best results are with Cialis 10mg/day combined with a cock ring, which I have used the last decade. Results are not optimal: cock ring has to be tight, which decreases sensation, without a cock ring I am unable to maintain an erection. As my erectile capacity is not totally hopeless, I was/am not totally convinced that a penis implant may improve my condition. I can have sexual intercourse and experience an orgasm. I am sexually active on a daily basis. I am afraid to lose what I have right now, even if it is not optimal. However, after balancing the pros and the cons I made the decision to opt for an implantation. I am scheduled for an operation in less than two months.

Reading the posts on FT has been very usefull, and provided me with a lot of information that scientific articles alone can not provide.

tomas1
Posts: 1358
Joined: Tue Jul 23, 2013 5:12 pm
Location: Tempe, AZ

Re: Impact of doctor on implant size?

Postby tomas1 » Mon Feb 10, 2020 11:32 am

I think it's worrisome that your doctor lowered the expectations but who knows?
My doctor was a terrible communicator and never measured me nor wanted to know my size.

I know you know that good surgeons take great care in the internal measurements.
Mine turned out to be perfect.

My doctor also gave me no post operative suggestions other than when sex would be OK.

I personally don't think it matters whether you are inflated or not post surgery.
Just try to cycle daily which doesn't sound like a problem for you.
81 years
Inject testosterone weekly.
Got implant on 1/22/19 by Dr Avila.
Scrotal, horizontal incision just over 1"
18cm AMS 700 CX, 3.5cm RTE 100cc reservoir
Diagnosed with Gleason 6 prostate cancer. Monitoring it for now.

LeRoastBeef
Posts: 277
Joined: Mon Sep 17, 2018 11:09 am

Re: Impact of doctor on implant size?

Postby LeRoastBeef » Mon Feb 10, 2020 11:52 am

REgarding the use of a ring, this is my biggest concern too.
I will question my Dr when i see him, and pray he says it's okay.

I assume that the way to avoid the tubing coming under the ring would be to minimise the use of RTE's, thus situating the tubes as far back (proximal-close to body) as possible. Thus the tubing would be set deeper in and any ring would be above it, even if the ring were to be at the base.

This is HUGE concern for me, as i don't get glans engorgement witout a ring, but a ring makes it all better.
This is my only concern with an implant, the rest i am looking foward to.
Venous leakage (Cavernosum and glans). 31yrs. In the process of getting an implant. Nervous but accepting it has to be done. Love Franktalk.

andrew1959nj
Posts: 256
Joined: Thu Jun 14, 2018 3:04 pm

Re: Impact of doctor on implant size?

Postby andrew1959nj » Mon Feb 10, 2020 12:57 pm

The Doctor matters. From my own experience, I lost both some length and girth with my implate which my doctor had said that I would. I'm no port star but my cock did present some size issues with some women. However, I have never experienced any pain from pumping up no matter how long I leave my clock inflated. I wouldn't mind if I could regain my size. Like most men, we are way more obsessed with our cock size than our partners are. They are way more factors that contributes to a great mutually enjoyable fuck than a big dick.
60 years old. MS and Severe ED 10+ years. Pills and injections never worked well. Implanted 5/16/2019 by Dr. Sadeghi. Titan 20cm + 2cm RTE.

newbie443
Posts: 483
Joined: Fri Dec 01, 2017 9:41 pm
Location: Sedgwick county, Kansas USA

Re: Impact of doctor on implant size?

Postby newbie443 » Mon Feb 10, 2020 3:33 pm

Ask to speak to one or more of your doctors implant patient's and ask them if and how much they lost. Hopefully you will get some positive reports.

Yes, doctors do make a difference. High volume doctors are a good place to start.

Perito uses infra pubic approach with tubes connecting on the top. Dose your uro use penoscrotal approach? Might make a difference for using a cock ring? I don't know. Just something that came to mind when I read your post. My glans engorged before surgery and do so after. But not as much as in my youth. I have read that this varies from person to person. I have read about a urethral muse and glans injections for those who do not.

Of the two most written about uro's on this board the NY doctor activates and starts cycling at 3 days post op. The Baltimore doctor activates and starts cycling at 3 weeks. My local uro's said 8 weeks. So I don't think there is a determined best. Best way to maintain size is to have a doctor who properly sizes you and follow his/her instructions post op. There has been articles and discussion on stretching for men who have lost size over years of ED. This is done pre and post op. Pre op stretching can be done with a VED. No cock ring is used. Just pump erect and leave for 10 minutes or so 3 times a day. This is to simulate the 2-3 natural erections men should have every day. Another is manual. Like the stretch test only in addition to the forward pull out, pull to the right, then left, up to your belly button, and down to the floor. Repeat this several times 2-3 times a day. The pre op stretching is done to make room for larger cylinders. Post op stretching is done with your implant after you have fully healed. If I remember correctly this would be aprox. 3 months post op. Until then follow your doctors instructions on activation and cycling. This stretching is done by inflating to the max and adding pumps every 5 or 10 minutes for up to an hour 2-3 times a day. Again stretching is for men who have lost size during the years of ed prior to implant.
Injections failed. Implanted 3-21-18 AMS 700 LGX 21 + 1 RTE 100 cc reservoir Dr. Kramer. https://youtu.be/QPu9pLBM0wM

62 years young.

Will show and tell and talk with others.

Luther
Posts: 9
Joined: Tue Oct 22, 2019 8:50 am

Re: Impact of doctor on implant size?

Postby Luther » Mon Feb 10, 2020 3:49 pm

Thank you all for your helpful replies.

I wonder how much room there (literally) is for a surgeon to increase (or decrease) the size of the implant without having an impact on functionality. As far as I understand, the goal is to get the implant's cylinder into beginning of the glans without it reaching all the way to the top. This would mean that optimal sizing from the standpoint of functionality and "esthetics" (i.e. maximum penis length) are almost the same. If that's the case; is the discussion about "agressive sizing" of certain specialists a gimmick to increase sales, or is there some truth in it?

Lost Sheep
Posts: 3158
Joined: Mon Jul 04, 2016 11:16 pm

Re: Impact of doctor on implant size?

Postby Lost Sheep » Mon Feb 10, 2020 4:00 pm

Luther,

Welcome to FrankTalk.

Luther wrote:Dear FT members, I have three question:

1) Does the choice of surgeon has a great impact of the size of your implanted penis? Or is the difference between surgeons not as big, as long as it is an experienced "high volume" doctor?

I had a pre-surgery consult last week which worried me a bit. In the consult, the stretched state of my penis was about an inch shorter than my normal erect penis size (7 vs. 8 inches). When I addressed this, the doctor said not to worry, and that my penis would keep it's current size. I understand that the measurement of the corpora on the day of the surgery is more important than the stretch test. However, the doctor made a remark that my size "was more than adequate for sexual intercourse" and that men should not be so concerned with their penis size, which made me clear his emphasisis' was on functionality and certainly not upsizing.


I would get a second opinion.

"Upsizing" is not something I would want to hear from my surgeon (that would set off an alarm in my mind suggesting he exaggerates his promised outcomes)

Emphasizing function is good, but giving short attention to size preservation also would set off an alarm.

Dr. Eid wrote to me, "Find a surgeon in love with his craft." He went on to say that such a surgeon will put his patients' ultimate outcome above all other considerations. Dr Eid takes pride in optimal outcomes of his patients - the best they can get. No more, of course, but not any less than the best outcome possible.

Your description of your pre-surgery consult suggests to me that your surgeon thinks "good enough" is his goal. My goal in any surgery is AT LEAST optimal and preferably to match my pre-surgery performance (or size) parameters. I recently had hand surgery. I play guitar and full dexterity and strentgh is VERY important to me. Wth my implant, full restoration of rigidity and size was similarly important, not just for ego, but because restoration is restoration. Restoring a classic car, you do the very best you can to match paint color, etc. A penis is no less important.

At the very least, I would do whatever it takes to get as full an erection now as you can and document it with photographs and measurments of length and girth. Then make sure he understands your expectations. I know of NO CONDITIONS (maybe, scarring in the corpora or something like that) that would prevent a surgeon from FULL restoration of pre-op erectile size. However, a conservative surgeon might err on the side of caution and permit a little size loss to ensure against over-sizing. In my opinion (for what THAT's worth) is that such practices (described in a paper I read from Montague, et al - I do not have the link handy) are out-of date.

I chose a surgeon who would TALK to me and accept me as a part of my medical care team. I would not willingly let any provider do anything irreversible to me who did not respect my desires and listen to (and take into account) my thoughts.

Get a second opinion or at least interview his former patients. Maybe he is just making a conservative estimate you so he can exceed your expectations afterwards.
Last edited by Lost Sheep on Mon Feb 10, 2020 4:43 pm, edited 1 time in total.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

Lost Sheep
Posts: 3158
Joined: Mon Jul 04, 2016 11:16 pm

Re: Impact of doctor on implant size?

Postby Lost Sheep » Mon Feb 10, 2020 4:27 pm

Luther wrote:3) What is the current consensus on best post-operative procedure for maintaining size? I read "we recommend leaving the implant inflated 60%–80% in the immediate postoperative setting for approximately 6 weeks", but I also read "during the first three months after the surgery the cylinders must be kept fully deflated in order to maintain the reservoir fully inflated. This will allow scar tissue to form on a full reservoir and prevent auto-inflation later on".

My opinion (of course, I am only a layman, so medical opinion value is fairly low) is that inflating BOTH the reservoir and the implant (essentially cycling them) is important. What length of time each is inflated is essential. Getting the reservoir fully inflated is more difficult because the pump does not force fluid in that direction. Or it may be easier because the reservoir is implanted in soft tissue. Getting the implant fully inflated is easier because the pump forces fluid in that direction, but also a little difficult because the implant inflates against the tunica albuginea.

Getting full fluid transfer in both directions is important and how one achieves that is a subject for you to discuss with your surgeon and post-op care team.


Luther wrote:1) Does the choice of surgeon has a great impact of the size of your implanted penis? Or is the difference between surgeons not as big, as long as it is an experienced "high volume" doctor?

More important than volume, publicity or how well-known the surgeon is, is the skill and dedication of the surgeon. It is possible for a relatively low volume, very skilled surgeon to do a great job. High volume nearly ensures a high skill level, so that is important but not an absolute necessity. Even more important is the dedication of the surgeon to 1) doing a good job (his ego plays in here) and 2) dedication to getting an optimal outcome for the patient (his compassion plays in here).

A high-volume surgeon who cares little for the patient's satisfaction would be immediately crossed off my candidate list. A low-volume surgeon who (with at least a threshold level of skill proven by a cohort of successful outcomes) would remain on my candidate list.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

Lost Sheep
Posts: 3158
Joined: Mon Jul 04, 2016 11:16 pm

Re: Impact of doctor on implant size?

Postby Lost Sheep » Mon Feb 10, 2020 4:49 pm

Luther wrote:Thank you all for your helpful replies.

I wonder how much room there (literally) is for a surgeon to increase (or decrease) the size of the implant without having an impact on functionality. As far as I understand, the goal is to get the implant's cylinder into beginning of the glans without it reaching all the way to the top. This would mean that optimal sizing from the standpoint of functionality and "esthetics" (i.e. maximum penis length) are almost the same. If that's the case; is the discussion about "agressive sizing" of certain specialists a gimmick to increase sales, or is there some truth in it?

The implant tip should fully fill the tip of the tunica albuginea. But without compressing the surrounding tissues so much that decreased blood flow to those tissues poses a risk of tissue death.

Think of sizing shoes. Too long a shoe and the shoe's toe sticks out beyond you toes, causing a tripping hazard. Too short a shoe and you risk injury to the ends of your toes.

The range (for a penile implant) between not enough and too much is unknown to me, but I suspect it is on the order of one centimeter (I get this suspicion from the fact that the implant manufacturers provide rear tip extenders (RTE) that allow the surgeon that degree of adjustment).

I note that Dr. Eid is said to have experimented with shaving off the RTEs to get in-between dimensions. Such is his dedication to getting optimal fit.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

stephen54
Posts: 274
Joined: Sun Nov 10, 2019 11:43 am
Location: Midwest

Re: Impact of doctor on implant size?

Postby stephen54 » Tue Feb 11, 2020 7:30 am

Luther wrote:Dear FT members, I have three question:

1) Does the choice of surgeon has a great impact of the size of your implanted penis?


Yes. Understatement. Surgeon choice impacts literally every element of your dick and for the rest of your life, so scrutinize ferociously and choose wisely and based on facts. Not feelings.

However, I would challenge the thought process going into implantation and being overly focused on "size". This goes directly to - what in fact are your goals going in to implantation? To keep the same exact size? Or to be able to fuck at will and effectively without much of a limit and with total reliable spontaneity?

I lost an inch of length and almost an inch of girth. While I hope to recover that size over time, at the moment I've traded a faulty, unreliable, anxiety-inducing dick for one which turns to absolute unrelenting steel in seconds. I desperately wanted a dick that could keep up with my libido and with my animal of a wife. The phantom, currently missing inch is so irrelevant to us. I would encourage you to consider this. If your normal erect penis was several inches shorter, maybe we're having a different discussion. But you're basically exactly what I was. I was 7.5 to almost 8.0" fully erect prior to implantation (on a mix of injections and pills). I was 6.5" girth. Losing almost an inch both directions was not what I wanted, but I understood it as a potential trade off for the other good stuff, and at 12 weeks here we are absolutely loving this Titan. It's a damn miracle.

Luther wrote: ...the doctor made a remark that my size "was more than adequate for sexual intercourse" and that men should not be so concerned with their penis size, which made me clear his emphasisis' was on functionality and certainly not upsizing.


It's not one or the other, though. It's a combination of both. So get on the same page with this surgeon or go elsewhere, fast, for another consult. "Adequate" is not his metric; it's actually YOURS. "Adequate" falls into the bucket of your perception and reality and experiences. Not his. While he's technically correct...I don't know that I care for what seems to be implied (namely, that whatever he leaves you with is, by his way of thinking, sufficient). I recommend having an extremely specific dialogue with your surgeon about specifically, precisely how he sizes. If he can't or wont' get into a description of his exact methodology and technique...I would walk away.

As to your questions about the glans...I can only tell you that, when I palpate my glans, I can very clearly feel where my cylinders end, the tips. The tip is...I would say...approximately halfway through the diameter of my glans. I'm estimating obviously. So while my glans is definitely smaller today, it stays straight in line with my dick and it is fully cooperating with everything we are asking it to do here. And we ask a lot of it. I would also add that...the way my tips are placed...feels...very very good. When I am thrusting, or when her hands are on me squeezing my dick, jacking me off...the back and forth pressure, the feeling I get from feeling the tissues of my dick repeatedly sliding across the cylinder tips...is almost unbearably GOOD. I really can't explain this. But it's a turn on and right now I'm a pretty big fan.

So have that very clear discussion with your surgeon. Ask and ask again. Bring questions. Take notes. If he hesitates on anything you need to know, move along. There are tremendous surgeons out there, well beyond the 2 names we always hear on FT. It's gotta be a great fit for you.
Last edited by stephen54 on Tue Feb 11, 2020 6:53 pm, edited 1 time in total.


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