I blog di Alessioempoli

Data 25 agosto 2016

IL PENE – 3°

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              FALLOPLASTICA

 

 (un po’ di teoria)

 

 

 

Visono molteplici tecniche di ingrandimento penieno che è un intervento per aumentare sia la lunghezza  che la circonferenza del pene.

Si possono utilizzare vari materiali protesici:

 

– Filler

– Macrolane

– materiali naturali: grasso e  derma liofilizzato

 

 

Intervento

 

L’intervento non interferisce con la sensibilità o la funzionalità dell’organo e viene eseguito quasi sempre con uno o due giorni di degenza. Il decorso postoperatorio è piuttosto rapido e il paziente in funzione dell’attività sedentaria o fisica che impegna il proprio corpo con potenziale rischio di microtraumi involontari al pene può espletare la sua normale attività professionale circa una settimana dopo l’intervento. La guarigione quindi è abbastanza rapida e si è già in piedi il giorno stesso dell’intervento.

 

 

Le metodiche

 

Sia  con le falloplastiche di allargamento che  con le falloplastiche di allungamento si ottengono aumenti sia in flaccidità che in erezione, sebbene l’aumento in lunghezza è generalmente più evidente in flaccidità.

 

Trapianto autologo

 

Consiste nel trasferimento di cellule adipose: lipopenoscultura.

Viene eseguita prelevando con un ago-cannula l’adipe in eccesso (liposuzione), spesso a livello pubico  o addomino-pubico, e poi viene  ri-iniettato sotto la cute prepuziale, per cui il pene diviene più grosso di circa il 30%..

Il risultato estetico in flaccidità è quello di un pene più lungo (essendo più pesante) e più grosso avendo una circonferenza maggiore.In erezione il pene è ulteriormente più largo in quanto si assomma all’aumento di diametro fisiologico che si viene ad avere in tale stato , quello della lipo-penoscultura. Bisogna sottolineare che in un numeroso numero di soggetti l’adipe può  riassorbirsi (spece nei fumatori) , dove il micro-circolo è alterato, per cui tale metodica è sconsigliata ai severi tabagisti cronici, che non hanno intenzione di smettere di fumare.

Solitamente l’adipe impiantato si riassorbe in 6-12 mesi.

 

Innesto di matrice di derma collagene liofilizzato coltivato in laboratorio

 

La tecnica più utilizzata  al mondo, di ultima generazione e definitiva  per la Falloplastica di ingrossamento del pene è quella dell’innesto di Matrice di Derma collagene lioflizzato coltivato in laboratorio, ( a-cellulare e quindi bio-compatibile con l’uomo), tessuto dermico acellulare utilizzato da tanti anni con successo nella chirurgia ricostruttiva delle grandi ustioni e nella induratio-penis-plastica.

Il Derma Liofilizzato   ha una similarità al tessuto cavernoso pari al 99%. Quindi è elastico ed ottimamente tollerato, senza alcun rischio di rigetto.

 

Viene innestato sopra il fascio cavernoso un foglietto di Derma con la funzione di ingrandire la circonferenza del pene. Con questa tecnica il pene aumenta del

25-30% definitivamente.

Con la nuova tecnica chirugica rivoluzionaria  , non vengono assolutamente toccati i corpi cavernosi nè aperti, il tessuto di Derma Porcino Intexen viene solamente appoggiato sopra il fascio cavernoso e fissato con dei micro punti di sutura che si sciogliearanno da soli.

 

 

Allungamento del pene

 

incisione Laser del legamento sospensore del pene e inserimento di distanziatore pubo-cavernoso.

 

L’aumento di lunghezza del pene sarà di circa 2-5 cm.

Ciò viene ottenuto incidendo una porzione del legamento sospensore pubo-penieno con un laser di ultima generazione.

All’interno sotto il pube sono infatti presenti altri 6-7 cm di pene.

L’unico fattore limitante è individuale ed è rappresentato dalla lunghezza di tale legamento sospensore, per cui non è possibile stabilire con precisione, in quanto situto in profondità e quindi non visibile.

 

retrazione cicatriziale del legamento

 

Il risultato in termini di lunghezza ottenuta è tuttavia spesso solo parziale e temporaneo, perché frequentemente si verifica la cosiddetta “retrazione cicatriziale” del legamento stesso. Questo processo, possibile in altri distretti del nostro corpo, fa si che una struttura sezionata chirurgicamente, possa spontaneamente “risaldarsi” (cicatrizzarsi) nel corso dei giorni successivi, vanificando così il risultato ottenuto. Tale situazione inizia a verificarsi già dall’immediato post-operatorio, e evolve con intensità variabile individualmente, come si è potuto accertare in corso di reinterventi.

 

Distanziatore in silicone morbido

 

Per ovviare a tale inconveniente viene usato un distanziatore in silicone morbido (materiale altamente sicuro ed usato da decenni in chirurgia plastica), che viene ricavato da una lamina più grande e modellato per incastrarsi perfettamente nello spazio creatosi a seguito della sezione del legamento sospensore. Infatti, lo scavo che viene a formarsi è diverso da persona a persona, ed il miglior risultato in termini di ricostituzione di una ottimale anatomia si ottiene misurando le dimensioni dello scavo stesso, e modellando direttamente in sala operatoria il distanziatore sulla base di questi dati. Per tale motivo ogni distanziatore è quindi “personalizzato”. Il distanziatore poi viene fissato con punti specifici al periostio dell’osso pubico, onde evitare anche ogni minimo spostamento.

 

Il distanziatore pubo-cavernoso, non interferisce in alcun modo con le funzioni a cui il pene è preposto. In altre parole, non vi saranno alterazioni dell’erezione, orgasmo, eiaculazione, minzione.

In più, il distanziatore è situato in sede profonda, e quindi non palpabile né tantomeno visibile. In fine, non dovrà mai essere rimosso, sebbene questo sia tecnicamente possibile.

 

Questo accorgimento di tecnica permette di rendere evidente e duraturo il risultato ottenuto. L’inserimento del distanziatore pubo-cavernoso, quindi, pur non essendo “obbligatorio” , è fortemente consigliato.

 

Questa procedura chirurgica ha un tempo tecnico di circa un’ora, e può essere eseguita in anestesia locale con sedazione, spinale o generale, a seconda dell’associazione con altre metodiche della designer falloplastica, della valutazione anestesiologica e dei desideri del paziente. La dimissione, così per ogni tipo di procedura adottata, anche nel loro insieme, è sempre nella stessa giornata, al massimo il giorno seguente.

 

 

Andropenis

 

In ogni caso noi raccomandiamo di eseguire sempre, nel periodo post-operatorio, esercizi di stiramento del pene al fine di prevenire la retrazione cicatriziale e ottenere gradualmente un maggiore margine di successo. Tal fine viene raggiunto dopo circa un mese dalla falloplastica con un apposito dispositivo:  l’ANDROPENISPenile -Stretcher che esercita una trazione continua e progressiva totalmente indolore, per i due-tre mesi successivi. Tutto ciò che bisogna fare è una semplice incisione, nell’area pubica per avere accesso al legamento sospensore pubo-penieno.

 

 

 

Cuscinetto adiposo pubico

 

Nei soggetti sovrappeso, la rimozione del cuscinetto adiposo nell’area pubica mediante liposuzione o “adipectomia pubica” può aumentare ulteriormente l’allungamento penieno ottenuto. Spesso si esegue un intervento di falloplastica di allungamento associato ad ingrossamento penieno in cui appunto vengono eseguiti nella stessa seduta operatoria sia l’allungamento che l’ingrossamento penieno.

 

 

Dismorfofobia peniena

 

Storicalmente,socialmente e sessualmente la stima di se stesso e della “self -image” è spesso a volte connessa alle dimensioni del propio pene.

La dimensione del propio pene è spesso per molti uomini sinonimo di virilità, forza, possesso nei confronti dell’altro sesso, non solo nella vita relazionale, ma anche nel sesso, nella intimità, non ultimo influisce nella relazione di coppia.

 

Per tale ragione anche la moderna psicosessuologia non minimizza più il problema del vissuto di chi ha un problelma dimensionale penieno.

La correzione della problematica dismorfofobica tramite falloplastica è finalizzata a migliorare in molti casi la self-immage sessuale del maschio.

 

 

 

Ipoplasia peniena

 

è un pene realmente piccolo.

 

Facendo i paragoni colla donna, è la stessa condizione che prova appunto la femmina nei confronti del propio seno, che puo’ variare dall’essere quasi piatto: ipoplasico, a borderline-piccolo o normale ma causa in tutti e tre i casi condizioni di disagio di entitò variabile. Tale disagio “estetico” nei confronti del propio pene nell’uomo è fonte di riverberi negativi non solo relazionali, nei confronti dell’altro sesso,sia verso se stessi (sindrome da spogliatoio:quando si evita di spogliarsi in palestra sottola doccia o in sauna ecc.).

 

Tale anomalia è spesso associata ad una condizione di sovrappeso o addirittura obesità per cui l’adipe del pube pre-penieno spesso ingloba la base (l’inserzione) del pene rendendolo ancor meno”visibile“.

 

L’ipoplasia peniena può dipendere da:

 

– cause genetiche

carenza di androgeni

non recettività agli androgeni da parte degli organi sessuali nella fase di sviluppo pre e post-puberale.

 

 

 

Trattamento psicoterapico di supporto

 

A volte prima di una falloplastica il maschio  ipodotato insicuro necessita previamente di una valutazione psicologica ma anche di un trattamento psicoterapico di supporto.

 

 

Si possono focalizzare tre tipi di dismorfofobia  peniena:

 

– PENE IPOPLASICO

– PENE DI DIMENSIONI BORDELINE-PICCOLE

– PENE DI DIMENSIONI BORDELINE-NORMALI (ma causante lo stesso severa dismorfofobia)

 

 

1 - 42k

 

2-43K

 

3-40K

 

4-36K

 

5-44K

Cuneo distanziatore pubo-cavernoso

impianto infrapubico del cuneo distanziatore pubo-cavernoso di Alei (al fine di evitare il riaccostamento del pube al pene e rendere stabile l’avanzamento del pene).

 

 

6-33K

Matrice di derma collagene liofilizzato coltivato in laboratorio

impianto sottoprepuziale  o di un patch (lembo) di Derma:  o autologo (prelevato da altra sede corporea,p.e. pieghe glutee) o Matrice di Derma Collagene liofilizzato coltivato in laboratorio ( biocompatibile con l’uomo e quindi non riassorbibile).

 

 

7-57K

 

8-38K

 

 

9-41k

10-67k

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