Autologous Dermal Fat Graft Augmentation Glansplasty for Management of Transmasculine Neo-glans Atrophy following Penile Prosthesis Placement
Rachel A. Moses, MD, MPH1, Amanda R. Swanton, MD/PhD1, Mang L. Chen, MD2.
1Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA, 2G.U. Recon, San Francisco, CA, USA.
Introduction: Neo-glans atrophy is a described complication following penile prosthesis insertion in the transmasculine neophallus in which the neo-glans appears hypoplastic despite proper device fitting. This aesthetic result may cause patient dissatisfaction with the neophallus. Additionally, though long-term outcome data in this population is not available, the decreased tissue support between the device and skin may predispose to cylinder erosion. The purpose of this abstract is to describe a novel technique to address neo-glans atrophy which utilizes interposition of a full thickness dermal graft to correct the hypoplastic contour.
Materials & Methods: We provide a description of an autologous dermal fat graft tissue transfer to address neo-glans atrophy. Steps include harvest of the graft from a non-hair bearing area, graft preparation, development of the plane for tissue insertion without disturbance of the prosthetic device, and graft placement within the neo-glans.
Results: Autologous dermal fat graft neo-glansplasty has been demonstrated to be a feasible technique that improves cosmetic appearance of a hypoplastic neo-glans following penile prosthesis insertion (see Figure) and durably address neo-glans atrophy in this unique population.
Conclusions:Reconstructive urologists managing patients with neo-glans atrophy following penile prosthesis insertion may utilize this technique. Further work is needed to gather data on long term outcomes with this technique.
Figure 1: Appearance of transmasculine neophallus with penile prosthesis previously inserted that demonstrates neo-glans atrophy pre-operatively (A), intraoperative correction with autologous dermal fat graft insertion (B), and post-operative outcome (C).
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