For younger guys who will need multiple surgeries throughout their lives - what are the risks of choosing IPP over MPP?

[neisseriaceae]

Hi!
check My post, You might find your answer

viewtopic.php?f=6&t=27116

[Kodixx]

It feels like waking up in the middle of the night with an infomercial on TV, and multiple people having an orchestrated conversation with each other. Complete with prepared stats, quotes, graphs, and each one complimenting the other on how they're thinking.

But best wishes to those who are genuinely making the implant decision -- which type, which manufacturer, which model and which doctor. There's a wealth of information and perspectives on FT to draw from. Just be sure to draw from a wide range of perspectives, not just one or two.

- Chuck

I think that analogy regularly comes from an account that does a Foghorn Leghorn cornpoke routine. It’s likely an alt account using AI of a notorious anti-IPP troll on this board. This topic is fairly likely to produce some crazy anti-IPP responses, which will unfortunately make it difficult to discern valid advice from craziness.

[daddel]

It feels like waking up in the middle of the night with an infomercial on TV, and multiple people having an orchestrated conversation with each other. Complete with prepared stats, quotes, graphs, and each one complimenting the other on how they're thinking.

But best wishes to those who are genuinely making the implant decision -- which type, which manufacturer, which model and which doctor. There's a wealth of information and perspectives on FT to draw from. Just be sure to draw from a wide range of perspectives, not just one or two.

- Chuck

I think that analogy regularly comes from an account that does a Foghorn Leghorn cornpoke routine. It’s likely an alt account using AI of a notorious anti-IPP troll on this board. This topic is fairly likely to produce some crazy anti-IPP responses, which will unfortunately make it difficult to discern valid advice from craziness.

tooyoung and his alter egos on this board

[dj_soros]

Hey everyone! I’ve just wrapped up an ultrasound with Dr Hakky’s team that confirmed I’ve had a venous leak - likely my whole life! I’m trying Trimix over the next few weeks but anticipate that I’m going to just pull the trigger on an MPP or IPP.

I’m in my early thirties - I haven’t had a chance to deep dive into the risks and long-term strategy of implant surgery with Dr Hakky just yet (I have my next appointment in early October) and I intend to ask him all the questions that I have… but until then, I wanted to get some thoughts and feedback from the guys here.

The big question: for younger guys who need an implant, does the MPP make more sense than an IPP? What are the arguments for and against for each, in the context of a younger patient who will need multiple surgeries throughout his lifetime?

Dr Hakky did tell me today that with the IPP - assuming no device issues - that a patient should GENERALLY anticipate needing a surgery every 8 - 12 years.

Assuming an IPP lasts me on the lower end (8 years ish), that’s 6 - 7 surgeries throughout my lifetime I’m anticipating (assuming I’m lucky enough to live to see my 80’s!). That’s a lot of surgeries - and I think it’s fair to assume that there WILL be some complication along the line (at least one of those IPPs might fail early, etc).

With the MPP, I know that it’s simpler and there’s way less risk surface area (less infection risk, less failure risk. Erosion risk may be marginally higher). Hakky implied these might last more like 15-20 years. That would only yield 3-4 surgeries throughout my lifetime. Not bad!

Taking into account a bit more significant recovery timeline required + a higher out of pocket cost if insurance won’t cover it, it has me wondering: is the juice worth the squeeze?

Make no mistake - I do suspect in my case, an IPP could be AMAZING. For starters, I’m on the smaller side both length and girth wise. Hakky did feel that I could actually improve my length and girth overall with an IPP, on account of the nature of my ED (the venous leak has likely prevented me from EVER reaching my full erection potential). This is a very attractive thing to me! I know the analogy on these forums tends to be that the IPP is the “Ferrari” of implants, whereas the MPP is the old reliable car that isn’t fancy but will get you there. I have to ask myself - would I be super happy with an MPP? Am I attracted to the potential gains from an IPP purely from an emotional standpoint? That I want to absolutely maximize the performance of my implanted penis after spending my whole life without “good wood” ? At this stage, it’s really hard to say - I’d feel obviously so bummed out if I pulled the trigger on an IPP only to have an early failure. At that point, I’d be REALLY wishing I had just gone for the damn MPP.

Then I know there’s the argument that the IPP is much easier to conceal. That all sounds fine, but to be honest that doesn’t worry me too much if I go with the MPP route, especially since I’m slightly smaller to begin with.

For my case personally, I do think there’s a chance that the implant is covered by insurance. I have Anthem BCBS PPO, I’ve tried pills, am trying shots, and have diagnostic proof that my ED is physiologic in nature. This definitely complicates things for me, because originally I was planning out of pocket payment and was leaning HEAVILY towards MPP. But if insurance would cover the IPP? That does make it more appealing to maybe take a chance on it.

Anyways, I’m sorry for the word-vomit gentleman. I’ve been obviously really thinking about all this today after my diagnostic appointment. It’s exciting and terrifying all at once! I read the success stories from both the IPP and the MPP bionic brothers, and it all seems very encouraging. I just want to make sure I adopt the right long term thinking and strategy. I know there’s no “one size fits all” when it comes to the implant strategy. Just need to really start weighing out the options and facts.


Thoughts?

I went through the same dilemma weighing my options. It’s definitely a tough choice for us younger guys who have a much longer horizon to think about. Do you get an IPP during your “prime years” and maybe switch to an MPP later in life or if the IPP malfunctions early? Or do you start with the MPP for its reliability while you’re younger and/or more financially vulnerable, then switch to an IPP once you’re older, better insured, and further along in life? I’m choosing the latter for the peace of mind.

What I’ve learned firsthand is that there are too many variables with insurance that are outside of your control. In the U.S., coverage depends on your employer. If your employer excludes implants, you’re paying out of pocket. If you lose your job, you lose your coverage (yes, there’s COBRA but it’s temporary and you’re paying premiums in full) and have to hope your next employer doesn’t also exclude it. And you won’t know what’s covered until you’re already hired, since the plan documents are only accessible to employees once they’re on the job. So you’re basically just blindly hoping it’s included.

ACA marketplace insurance can cover implants, but it varies by state and plan (these documents are public so you can check your state’s). Many providers might not accept marketplace patients because their reimbursement is lower, so even if it’s covered, access can still be difficult.

Also, make sure you actually check your employer’s plan documents (or call). Just because someone says their BCBS covered it doesn’t mean your BCBS plan will. Employer plans vary widely in what they choose to cover.

On the flip side, some implant surgeons and even the manufacturers have insurance reps who are really skilled at finding the right billing codes or coverage loopholes to get an appeal approved, so that’s also something worth exploring.

If I have to pay of of pocket, it would be for an MPP. principles experience is what I want to limit probability of (thankfully he is good now), but that would financially wreck me.

If we had Medicare for All or if I were wealthy, I’d go with the IPP immediately. But given the realities, the MPP feels like the safer for me right now.

[LastHope]

......
And you won’t know what’s covered until you’re already hired, since the plan documents are only accessible to employees once they’re on the job. So you’re basically just blindly hoping it’s included.
......

This is an eye-opener for me! Thanks, dj_soros, for being so thorough in covering these blind spots!

[thx1138]

Is the Ambicor still available ?

[dj_soros]

Hey everyone! I’ve just wrapped up an ultrasound with Dr Hakky’s team that confirmed I’ve had a venous leak - likely my whole life! I’m trying Trimix over the next few weeks but anticipate that I’m going to just pull the trigger on an MPP or IPP.

I’m in my early thirties - I haven’t had a chance to deep dive into the risks and long-term strategy of implant surgery with Dr Hakky just yet (I have my next appointment in early October) and I intend to ask him all the questions that I have… but until then, I wanted to get some thoughts and feedback from the guys here.

The big question: for younger guys who need an implant, does the MPP make more sense than an IPP? What are the arguments for and against for each, in the context of a younger patient who will need multiple surgeries throughout his lifetime?

Dr Hakky did tell me today that with the IPP - assuming no device issues - that a patient should GENERALLY anticipate needing a surgery every 8 - 12 years.

Assuming an IPP lasts me on the lower end (8 years ish), that’s 6 - 7 surgeries throughout my lifetime I’m anticipating (assuming I’m lucky enough to live to see my 80’s!). That’s a lot of surgeries - and I think it’s fair to assume that there WILL be some complication along the line (at least one of those IPPs might fail early, etc).

With the MPP, I know that it’s simpler and there’s way less risk surface area (less infection risk, less failure risk. Erosion risk may be marginally higher). Hakky implied these might last more like 15-20 years. That would only yield 3-4 surgeries throughout my lifetime. Not bad!

Taking into account a bit more significant recovery timeline required + a higher out of pocket cost if insurance won’t cover it, it has me wondering: is the juice worth the squeeze?

Make no mistake - I do suspect in my case, an IPP could be AMAZING. For starters, I’m on the smaller side both length and girth wise. Hakky did feel that I could actually improve my length and girth overall with an IPP, on account of the nature of my ED (the venous leak has likely prevented me from EVER reaching my full erection potential). This is a very attractive thing to me! I know the analogy on these forums tends to be that the IPP is the “Ferrari” of implants, whereas the MPP is the old reliable car that isn’t fancy but will get you there. I have to ask myself - would I be super happy with an MPP? Am I attracted to the potential gains from an IPP purely from an emotional standpoint? That I want to absolutely maximize the performance of my implanted penis after spending my whole life without “good wood” ? At this stage, it’s really hard to say - I’d feel obviously so bummed out if I pulled the trigger on an IPP only to have an early failure. At that point, I’d be REALLY wishing I had just gone for the damn MPP.

Then I know there’s the argument that the IPP is much easier to conceal. That all sounds fine, but to be honest that doesn’t worry me too much if I go with the MPP route, especially since I’m slightly smaller to begin with.

For my case personally, I do think there’s a chance that the implant is covered by insurance. I have Anthem BCBS PPO, I’ve tried pills, am trying shots, and have diagnostic proof that my ED is physiologic in nature. This definitely complicates things for me, because originally I was planning out of pocket payment and was leaning HEAVILY towards MPP. But if insurance would cover the IPP? That does make it more appealing to maybe take a chance on it.

Anyways, I’m sorry for the word-vomit gentleman. I’ve been obviously really thinking about all this today after my diagnostic appointment. It’s exciting and terrifying all at once! I read the success stories from both the IPP and the MPP bionic brothers, and it all seems very encouraging. I just want to make sure I adopt the right long term thinking and strategy. I know there’s no “one size fits all” when it comes to the implant strategy. Just need to really start weighing out the options and facts.


Thoughts?

I went through the same dilemma weighing my options. It’s definitely a tough choice for us younger guys who have a much longer horizon to think about. Do you get an IPP during your “prime years” and maybe switch to an MPP later in life or if the IPP malfunctions early? Or do you start with the MPP for its reliability while you’re younger and/or more financially vulnerable, then switch to an IPP once you’re older, better insured, and further along in life? I’m choosing the latter for the peace of mind.

What I’ve learned firsthand is that there are too many variables with insurance that are outside of your control. In the U.S., coverage depends on your employer. If your employer excludes implants, you’re paying out of pocket. If you lose your job, you lose your coverage (yes, there’s COBRA but it’s temporary and you’re paying premiums in full) and have to hope your next employer doesn’t also exclude it. And you won’t know what’s covered until you’re already hired, since the plan documents are only accessible to employees once they’re on the job. So you’re basically just blindly hoping it’s included.

ACA marketplace insurance can cover implants, but it varies by state and plan (these documents are public so you can check your state’s). Many providers might not accept marketplace patients because their reimbursement is lower, so even if it’s covered, access can still be difficult.

Also, make sure you actually check your employer’s plan documents (or call). Just because someone says their BCBS covered it doesn’t mean your BCBS plan will. Employer plans vary widely in what they choose to cover.

On the flip side, some implant surgeons and even the manufacturers have insurance reps who are really skilled at finding the right billing codes or coverage loopholes to get an appeal approved, so that’s also something worth exploring.

If I have to pay of of pocket, it would be for an MPP. principles experience is what I want to limit probability of (thankfully he is good now), but that would financially wreck me.

If we had Medicare for All or if I were wealthy, I’d go with the IPP immediately. But given the realities, the MPP feels like the safer for me right now.

Very informative on the financial aspect...thank you for that. But I’d like to point out that one of the major concerns with undergoing a revision is the renewed risk not limited to: malsizing, poor pump or tubing placement, and especially infection. According to Köhler’s study, each subsequent revision carries a higher risk of infection than the previous one.

I’m 27 with refractory ED and I would’ve opted for an IPP if it weren’t for the persistent sense of insecurity because of malfunctions and revision related infections.

In my home country, Titan costs $8,500 all inclusive at a Coloplast Center of Excellence with surgeons performing 40+ ipps per month, with a lifetime warranty on mechanical failure. But still, I can’t afford to live fingers crossed during the prime of my career and relationships.

Good point, that’s another hard truth younger guys have to face, and another reason why having refractory ED so young feels devastating. Strangely, it’s something I almost never hear emphasized in implant educational videos or forums. Revisions are usually framed as “easier recovery” or “you’ll get a larger implant,”, "if you go to a center or excellence infection rates are minimal". I was never aware that more revision increase risk of infection.

I’m around your age as well, and I really tried to find a way to make an IPP work for me. But in the end, I just couldn’t go through with it in good conscience while knowing these hard truths.

Even with insurance, I’m still paying about $8k for my malleable, which is roughly half of what I’d be paying out of pocket. It's still a significant cost for me.

I do think I would eventually upgrade to an IPP someday, but much later in life. By then, I’m hopeful Coloplast will have improved the tubing issue, and I’d have much more confidence going that route.

[JohnnyBorg]

It’s really interesting because in all the research I’ve done in the past year, I was heavily leaning toward the MPP. Especially because I was CERTAIN I’d pay out of pocket (it’s likely I still might have to!), and also because I’m generally a bit more risk averse.

After my recent trip to see Hakky though, I of course have to admit that the prospect of potentially gaining a little length and girth with an IPP is very tempting. But I think if I cool on it a little bit… I do still think the MPP could be right for me. It’s that question of whether I want to roll the dice a little bit and potentially get some gains I wasn’t expecting - or go with an approach that for me might offer a bit more general peace of mind.

I really do wonder what the potential gains from the IPP could be in my case. If it’s only like a quarter inch or even a half inch of length, I really don’t think that’s major enough to warrant it. Right now, when it’s a good day and I can achieve erection, yeah I typically sit ~5 inches. I’ve never been truly unhappy with my size even though it’s nothing to write home about

With the MPP, is it typically sized close to where you currently are at when erect? I recall a video from Hakky actually indicating with MPP he typically will undersize 1 CM for healthy patients, and 2 CM for someone who is diabetic or immunocompromised. If I recall, this was done intentionally to help mitigate erosion risks.

[LastHope]

My surgeon admitted (after the surgery ) that he intentionally downsized my rods by 1 cm to reduce the biologically plausible higher risk of erosion with rod implants.

Interestingly, I haven’t noticed any loss in length. My pre-op SPL (stretched penile length) is the same as my post-op flaccid length. How that’s possible? I don’t know....but I still tell my bros that I might have lost 1 cm. I just don't want my placebo effects or measurement errors to influence others in their decision making.

[JohnnyBorg]

My surgeon admitted (after the surgery ) that he intentionally downsized my rods by 1 cm to reduce the biologically plausible higher risk of erosion with rod implants.

Interestingly, I haven’t noticed any loss in length. My pre-op SPL (stretched penile length) is the same as my post-op flaccid length. How that’s possible? I don’t know....but I still tell my bros that I might have lost 1 cm. I just don't want my placebo effects or measurement errors to influence others in their decision making.

Yep, that’s right in line with the expectations Hakky sets in his YouTube video about malleables. I’m totally cool with a 1 cm reduction if it helps mitigate erosion risks.

LastHope - I forgot from your previous posts, do you still get some engorgement with your Genesis? Is there a difference in girth or length from when you’re aroused vs unaroused? This is something I’m curious about with the MPP’s - how different they look and/or feel when you’re aroused vs just going about your day.