What are the risks and complications of surgical penis enlargement (phalloplasty)?

1. Phalloplasty’s most common and predictable complications

Phalloplasty—used for gender-affirming or reconstructive aims—regularly produces specific surgical problems: urethral complications (fistula, stricture, leaking or narrowing), partial or total flap loss, wound breakdown, and persistent pain or sensory changes; donor-site issues (scarring, decreased mobility, poor wound healing) are common as well ^{[8] [5] [6]}. Systematic and narrative reviews advise staged surgery and multidisciplinary teams because partial flap loss and urethral failures are frequent and can require further operations ^{[9] [10]}.

2. Quantifying risk: high re-presentation and complication rates

Population and database studies show substantial downstream healthcare use: a California statewide cohort found 55.3% of patients had readmissions or emergency/ambulatory visits for phalloplasty complications and estimated that half of patients re-present by one year ^[1]. Other series and NSQIP-derived reviews report overall complication rates that can be very high — some analyses cite complication rates up to about three quarters in selected datasets — underscoring that complication frequency depends on technique, setting, and how complications are defined ^{[11] [1]}.

3. What drives those risks: anatomy, technique and patient factors

Complication risk varies with flap type (radial forearm, anterolateral thigh, suprapubic pedicled flaps), whether urethral lengthening is performed, surgeon experience, staging strategy, and patient comorbidities like obesity, smoking, diabetes or immunosuppression ^{[5] [12] [13]}. Centers stress preoperative optimization (stop nicotine, lower BMI), hair removal at donor sites, and psychosocial evaluation to reduce avoidable complications and improve outcomes ^{[14] [9] [13]}.

4. Cosmetic penile augmentation (non‑phalloplasty) — different problems, sometimes worse outcomes

Procedures aiming purely for length/girth (ligament release, fat grafting, fillers, silicone or proprietary implants) carry a different but serious risk profile: infection, abscesses or nodules, granuloma or migration of injected materials, penile shortening or deformity, gangrene, erectile dysfunction, and frequent need for corrective surgery or implant removal ^{[7] [2] [3]}. Case series and reviews emphasise that some techniques remain experimental with potentially disabling complications ^{[2] [15]}.

5. Long-term functional and sexual outcomes are mixed

Sexual health outcomes after phalloplasty vary by technique: some reviews show differences in postoperative sexual desire and orgasm rates across flap types and report that roughly half of patients with certain techniques achieved orgasm in pooled data, but many studies note gaps in long-term data and quality‑of‑life metrics ^[16]. For cosmetic augmentation, long-term functional compromise (ED, deformity) is well-documented in complication-focused series ^[3].

6. Patient counseling and realistic expectations are essential

Clinical guides and surgical programs emphasize informed consent: many centers require mental‑health assessments, detailed counseling about staged procedures, anticipated scarring, possible need for multiple revisions, and that some goals (e.g., reliable penetrative intercourse with natural erectile function) may not be achievable without prostheses or additional procedures ^{[14] [13] [6]}.

7. Where reporting and evidence are limited or contested

Available sources show wide variation in reported rates and note methodological limits: single‑center cohorts, referral bias in complication series, and differing definitions of complications all affect conclusions ^{[9] [17]}. Some commercial or clinic sites report high satisfaction and lower complication claims, but complication registries and independent reviews document substantial morbidity — readers should weigh both outcome studies and complication registries when evaluating claims ^{[18] [4] [17]}.

Bottom line: both reconstructive phalloplasty and cosmetic penile enlargement carry substantial, well‑documented risks — urethral breakdown, flap loss and donor‑site morbidity for phalloplasty, and infection, deformity, graft/implant complications or erectile dysfunction for cosmetic augmentations — and many patients will need further procedures or interventions ^{[8] [1] [2] [3]}. Available sources do not mention any single operation that eliminates these risks.