Buried penis is a troublesome subject.. Let me write this first..

It is difficult to correct and there is always the possibility of recurrence. The surgeon, who sees this surgery as a simple liposuction and penis lengthening, makes a big mistake. Buried penis cases are cases where you have to be approached very aggressively and do whatever you can to get the penis out. So you have to use all your ammo at the same time..

A difficulty in these cases is that there are different cases of burial that arise from very different causes. If you correctly determine why the penis is buried, for what reason, you will get more accurate results. If the cause of the situation is not determined correctly, good results cannot be obtained, you will miss the target.

There are many reasons such as excessive fat accumulation around the penis, excessively loose abdominal skin, insufficient foreskin removal, excessive foreskin removal, excessively loose penis skin, excessive development of the ligaments holding the penis (suspension ligament is not the only ligament holding the penis!). Because of this, the penis may be buried.

The expectation of buried penis cases is high. While the penis is sunk in, the patient waits for the penis to stand 10-12 cm outside and swing downwards... which is very difficult...

The patient may be overweight (VERY IMPORTANT NOTE: By the way, let me state that the buried penis will not only be in obese patients, but also in extremely thin patients..). In overweight patients, excess tissue around the penis may need to be removed by liposuction or tummy tuck.

Even if the penis is surgically removed 3-4 inches, this is a success, but if the patient has high expectations, the patient may not be satisfied with the result.

Worst thing before worst is a relapse of the embedded condition. Due to the edema that will occur as a result of the surgery, the penis may become buried again. In this case, it may be necessary to wait for a long time for the edema to resolve (6 months-1 year).

The worst thing that can happen is that the penis cannot be removed despite surgery. At this point, I should point out: The definition of the buried penis is; "the length of the penis is actually within normal limits, but the penis is recessed in". That is, the penis is buried, but inside there is normal-sized penile tissue that can be pulled out. But in some cases, the penis is both short and buried; so there is actually no penile tissue that can be pulled out. In these cases, results cannot be achieved (the worst of all genital aesthetic cases: both short and buried penis cases). Even if the penis is taken out with the surgical technique, it is buried again in a short time. These cases are the worst of buried penises. In fact, by definition (read the definition I wrote above) they are cases of short penis, not buried penis. If a penis is buried, the penis size (including the inside) must be within normal limits in order to call it a "buried penis". If the penis is both buried and short, this case is not actually a buried penis, but a short penis case, and the surgery cannot be done very well, often the shortness and buried state recur.

It is not easy to understand whether the patient's condition is "short penis" or "buried penis". A good physical examination is essential. There is no radiology or blood test that can clarify the situation. In fact, the patient's condition becomes clear when it is seen how far the penis can be slipped out when the suspensory ligament is cut during surgery. So -in my opinion- It is not possible to promise that there will definitely be results in buried penis cases. Can we get results from the surgery, or is it not possible because the patient has a short penis case? It is definitely evident when the suspensory ligament is completely cut and the penile tissue is released and slid out.

So, can't we get results from these buried penis cases? Is there no solution? Let me explain.. Let's continue..

Patients who come with a buried penis problem should know the following:

- 1: The case of the buried penis should know that the elongation in the penis, the protrusion of the penis will be limited. He should not dream of a 10-12 cm penis hanging outside like that..

- 2: Buried penis is a very stubborn problem. Buried penis may recur after a while. The remedy for this is to perform a revision surgery when the time comes (months pass and the stitches at the surgical site soften). The patient must be patient. Generally, only hospital expenses are taken in revision surgeries. The patient should also be prepared for these possible additional costs.

- 3: Buried penis surgery is not guaranteed. If the patient also has a short penis, no results can be obtained. This situation becomes clear only during the operation. The doctor should be realistic and explain these to the patient from the beginning; It is necessary not to utter a lot of guaranteed words and create empty expectations in the patient. Since I am a "realistic" surgeon, I tell patients about such possible problems from the very beginning, and that's why I'm writing here.

The success of the surgery completely depends on the correct determination of the causes of the buried penis and the correct actions for the cause.

Let's briefly list the causes of buried penis and look at what can be done:

Obesity: It is the most known (and most common) cause of buried penis. In these patients, lengthening of the penis, removal of fat from the bottom of the penis, tummy tuck if necessary, panniculectomy (surgical removal of the fatty tissue around the penis), opening of adhesions outside the suspensory ligament at the root of the penis, advancing the penis out and putting repulsive stitches behind it are required.

Excessive skin removal in circumcision: It is one of the worst circumcision mistakes. In circumcision, most of the penile skin may be removed and 1-2 cm of skin may be left behind. In this case, the penis remains buried inside, as its skin is very inadequate. It is necessary to remove the penis again with surgery and the skin deficiency should be completed with a skin patch taken from the leg.

Abdominal skin is too loose and it slides down and piles on the penis, resulting in a buried penis: These patients are usually very weak. There is almost no fat in the abdomen, but the abdominal skin slides down and collects on the penis and it is seen that the penis is embedded in the skin. In these patients, reverse tummy tuck (tightening the skin piled up on the penis, like tummy tuck, but not from the top down, but from the bottom up) can be performed. In addition, the foreskin seems to have been removed incompletely. If the foreskin is still visible after a reverse tummy tuck, circumcision can be performed. The aim is to eliminate the reasons for the embedding of the penis in the skin.

Apart from clearly identifying the source of the problem in the treatment of buried penis cases and taking action for this problem, I think there is another very important thing: aggressive surgery.. So everything that can be done must be applied clearly. In the treatment of buried penis, it is not necessary to say "it is enough to do this and that". "We will do this, this, this and that. We will even do these things that I have developed after we do the things that are written in the books." I have to say. There are many surgical maneuvers written in the books in this surgery. Apart from these, there are surgical maneuvers that we have developed over the years and that we think of during operations and operations. All of these should be applied aggressively. So to treat the buried penis it is imperative to engage in full-force with all the ammo.

As they say, the worst of the bad... It can be a bad situation if the penis is both short and buried: the penis is both short, buried and retracted. Retracted means that the spongy body tissue of the penis collapses and shrinks. If there is such a situation, the patient's surgery will definitely not yield any results. Such patients should not be accepted for surgery.

I can list the procedures generally performed as follows: cutting and lengthening the suspensory ligament, removing the fat around the penis with liposuction or panniculectomy (surgical removal of excessive fat accumulation at the base of the penis), opening other adhesions around the body of the penis, suturing the skin at the base of the penis to the penile tissue from the inside (suturing with non-melting threads). It is recommended), suturing the skin at the base of the penis to the deep tissue, performing circumcision if the foreskin is missing, and replacing the missing skin with a skin patch taken from the leg if the skin is removed during circumcision.

After all, buried penis is a stubborn and difficult problem that can be treated. Only patients should be selected well; Patients with unsuccessful results should not be accepted for surgery.

The patient should not keep his expectations high, he should be patient, he should be ready for the possibility of recurrence. Do not be hasty during the treatment, if you help your doctor, the results will usually be obtained from the treatment.

Op. Dr. Oytun İdil

(Plastic aesthetic and reconstructive surgeon)

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• Op. Dr. Oytun İdil: +90 533 569 0649
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