Penile Elongation - Lengthening

        The technique most commonly used for penile lengthening is the release of the suspensory ligament in combination with skin plasty in the form of an inverted V-Y or Z-plasty. This technique has drawbacks such as the possibility of re-attachment of the penis to the pubis, a hump that forms at the base of the penis, in addition to alteration in the angle of erection.
 

        In 2005, I proposed the technique of

AY PLASTY

which is capable of avoiding the fore mentioned drawbacks of elongation: The suspensory ligament is released through a peno-pubic incision. The caudal flap of the resected ligaments is reflected caudally and sutured to Buck’s fascia. An "A" is incised. The caudal half of the "A" is de-skinned, leaving a cranial skin covered triangle, and a caudal, rectangular fat flap. The fat flap is pulled into the gap between the base of the penis and the pubis, and secured in position by suturing its deep surface and lower edge to the pubis. The base of the penis is sutured to the base of the skin rectangle, thus pulling it out. This maneuver fills up the gap. The "A" is closed as a "Y". The peno-pubic incision is closed as a T-shape, to avoid pulling the penis back at skin closure.

Refining Penile Lengthening: “V-Y Half-Skin Half-Fat Advancement Flap” Combined With Severing The Suspensory Ligament
O.K.Z. Shaeer, K.Z. Shaeer and A. El Sebaie
J Sex Med 2006;3:155–160
 

Peno-pubic incison	Suspensory ligament cut	An "A" is cut
The caudal rectangle is de-epithelialized: the fat flap	Fat Flap burried into the cavity, and the skin triangle sutured to the proximal penis, ending in T closure

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