Tissues thinning over time

[wolfpacker]

I got my first implant in 2021, almost 4 years ago, and the tissues in my shaft and glans seem to have thinned out drastically in that time. I feel way more implant material and much less penis tissue in the shaft than in the first year, and in the glans when flacid I touch and feel almost only the hard implant tips. Really don't feel much glans tissue when flacid. Has anyone else experienced this atrophy over several years?

[Donkeykong]

I'm sorry to hear that. Did this change after your second surgery? Is it different from before when erect and aroused too?

[wolfpacker]

I'm sorry to hear that. Did this change after your second surgery? Is it different from before when erect and aroused too?

I wouldn't say it's drastically changed after the second surgery, just slowly progressed over the years. Erect/aroused is still good but also noticeably less than during the first year

[Parmenides]

I got my first implant in 2021, almost 4 years ago, and the tissues in my shaft and glans seem to have thinned out drastically in that time. I feel way more implant material and much less penis tissue in the shaft than in the first year, and in the glans when flacid I touch and feel almost only the hard implant tips. Really don't feel much glans tissue when flacid. Has anyone else experienced this atrophy over several years?

I noticed something similar but after years. It was something progressive and very slow. The implant has worked for 15 years and recently failed. But the good feeling of the first years in which when I was excited I hardly noticed the prosthesis disappeared and the prosthesis became more and more noticeable, especially the distal part and the tips. I discussed it with the doctor and he told me to try viagra, cialis... as it would help increase blood flow. Since it is a topic that is not discussed in the forum, I thought it was a personal circumstance given my background (Peyronie's, several failed implants...).

[SwedishDave]

This for sure is a good and necessary topic to discuss. My uneducated conclusion is that this might be more prevalent with the titan that constantly pushes the tissues and is also pretty hard when flaccid and barely decreases in length. I think that implants like lgx might be less tissue eroding because its the opposite, softer in flaccid and not always pushing the tips in the glans.

Pure speculation from a non-implanted guy tho. Maybe its the same for all implants i dont know, maybe its the cycling that sufficates the tissues and causes fibrosis. No oxygen = fibrosis.

Also, this eroding might be part of the reason that during revision you’re almost always upsized. Some people who had revisions say ”i dont notice any length difference even tho i was upsized 2-3cm, which is weird, but would make sense if there is just more space distally and proximally in the tunica.

[LastHope]

With my 24/7 hard implant, I have significantly higher odds of pressure atrophy. After my post-op recovery, as a therapeutic strategy, along with my daily dose of encorgement from orgasm, I'll also take a daily dose of Tadalafil for enhancing my penile micro-vascular health.

Even though Dr. Eid talks about this in one paper around RTEs, it may apply to the entire implant space and may be proportional to the pressure or an individual's higher predisposition to tissue atrophy.

"Penile prostheses form a pseudocapsule after implantation. For the inflatable component of the implant, inflation of the implant allows the material to fill the entire space within the pseudocapsule. However, anecdotally, we have found that the pseudocapsule around the non-expanding rear tips gradually dilates over time, and pressure atrophy with gradual compression of the surrounding cavernosal muscle and tunica thins out the flesh of the penis. The dilation may cause the device to “wobble” proximally, more so if more rear tips are used. In our experience, this phenomenon is more pronounced with malleable penile prostheses."

Reference:
Sexual Medicine Reviews journal, 2019 Jul
The Rear Tip Extender for Inflatable Penile Prostheses: Introduction of "Rigidity Factor" and Review of the Literature.
Thirumavalavan N, Cordon BH, Gross MS, Taylor J, Eid JF.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6559880/

[LastHope]

My apologies guys, for the seemingly off-topic comment. A similar concern runs in women with breast implants, and I thought this might add some interesting perspective to this discussion. Maybe our implant specialists who champion HA fillers will have some patching tools in their pocket for the atrophy caused by penile implants.

Question:
A few months ago I thought that my implants had ruptured because they seemed smaller. Now, after some research, I believe my own breast tissue is thinning. My upper chest seems very flat and the implants seem to be low. Will a breast lift fix that? What can I do?


6 answers from board certified plastic surgeons:

#1
we can see this problem with:
aging
large implants
weight loss

we can see improvement with:
fat grafts
mastopexy
combination of both

#2
One of the lesser known complications of breast implants is that they can cause thinning of the overlying breast tissue. This is the result of pressure from the breast implant that injures the breast tissue. The larger the implant,. the more the pressure, and possible the more the thinning. This is the reason why you should avoid choosing very large implants in small tight breasts. Unfortunately there is no easy fix to this once it has occured. One thing to do is change yoru implants to silicone because there will be less visibility and palpability beneath your thin tissue. Also, the implants should be placed (or moved) beneath the chest muscle because this will add an extra layer over the implant. To replace thin tissue, fat injections can be placed or acellular dermal matrix such as Alloderm or Strattice can help to thicken the breast tissue. If your implants have "dropped" because of the weakend tissue has lost support, then you may require breast fold reconstruction to help them stay up. The biggest key is to try to avoid this problem all together by appropriately choosing and implant volume that is best for your size, breast measurement, and tissue quality.

#3
The thinning of the breast tissue is very common post augmentation and we See that more with the above the muscle implants. Your best option is fat grafting to give you volume and also softness.

#4
Breast tissue thinning is a common long-term occurrence in some patients from the pressure of the implants. (squeezing the fat between the implant and the skin) It tends to occur in larger implants and those that are placed above the muscle. It is also possible that it may also be a factor of skin becoming more lax over time and after pregnancies or weight loss. There is no standard way to try and improve this 'problem'. Options include exchanging to larger implants to create the perception of more fill and firmness from the outside or placing some form of tissue grafts between the implants and the skin. Fat injections would be the only really good choice for tissue replacement due to the versatility of how and where they can be placed.

#5
We have been getting excellent results with fat transfer to the breast and this might work well in your situation.

#6
Thinning of natural breast tissue is a common occurrence after breast augmentation surgery. Human tissues respond to the stresses applied to them which is why muscles and bones get bigger and stronger with exercise. Fat in the breasts, however, tends to do the opposite when pressure is applied to it in the form of breast implants. It tends to occur less with smaller implants and with the implants under the muscle. Unfortunately, there is not a lot that can be done about it.

If your implants have dropped too low resulting in a flat appearance to the upper part of your breasts, it is possible to have them repositioned higher. It is not uncommon to feel that you have gotten smaller as your implants have dropped. This may be the primary reason as to why you feel that you have gotten smaller rather than actual thinning of your breast tissue.

https://www.realself.com/question/fixes ... d-implants

[Eloquent]

Very interesting, topic and the more important for us young implantees! Parallel to breast implants is very useful.

I see your point but I am unsure whether we fully understand the problem. I think there are situations when tissue will atrophy with pressure and when it will stretch and accommodate without any problem. For example, look at obese people who gain or lose weight, the surrounding skin and tissue will accommodate or in the case of losing weight quickly will remain and have to be surgically removed, there is not a problem with the tissue stretching. An example of stretch with atrophy will be oversized MPP when the tips will erode.

Mayby the erosion is a situation will multiple factors at hand - aging, lack of oxygenation, high pressure, high blood pressure, diabetes

I am also wondering, could the pressure penile thinning happen only in tips or also on the sides of the penis/shaft?

I am also curious about the rate of tissue atrophy. Perhaps the rate is faster during the first few years because the tissue, which was previously oxygenated by the corpus cavernosum arteries, begins to deteriorate as these arteries are destroyed during surgery. However, after this initial phase, the rate may slow down or stop because the shaft and skin receive blood supply from different sources.

I think we need some member to discuss these questions in depth with a top implanter when he goes for a consultation . It would be very nice to get the answers.

[sambalamba]

I had discussed this with Hakky and he had said that tissue thinning is expected to happen over time. I only discussed the thinning of remaining corporal tissue and not the glans. To enhance tissue survivability he said to keep cylinders fully deflated when not in use.

My personal thinking is regular use of a VED to bring blood flow would reduce this thinning process.

Not sure if CX or Titan causes more thinning or not. I would think glans thinning would be the same since longitudinal pressure would be the same with both implants. Also Eid always prefers Titan. If Titan causes significant more thinning he would have a lot more unhappy customers which doesn't make business sense.

What do you guys think?

[Eloquent]

The thinning of the glans penis should in theory not occur at all if the surgery goes smoothly and nerves are not damaged? The arterial blood supply to the glans penis is around the urethra which is not affected by the surgery.

Comment:
"The glans penis receives blood from the internal pudental artery through its branch, the dorsal artery of the penis, which also supplies the foreskin, and the penile shaft."

So somewhat the blood supply of glans could be altered, it gets blood even from the dorsal artery and the penile shaft, the penile shaft blood supply is destroyed mostly.

Recently introduced prostheses from Rigicon have even more girth than titan:

AMS CX/LGX - girth per stick 18mm
Coloplast Titan - girth per stick +21mm
Rigicon - girth per stick 23mm