A Brazilian surgical technique that uses a patient’s own tissue increased mean flaccid penile length by 2.5 cm and penile circumference by 1.8 cm in a prospective pilot study while also improving genital self-image and reducing distress related to penile size.

An article published in the World Journal of Urology describes, for the first time, a novel surgical technique for penile girth augmentation developed by the urologist Ubirajara Barroso, Jr, MD, PhD, at the Federal University of Bahia, Salvador, Brazil.

The prospective, interventional, nonrandomized study included 32 adult men with a mean age of 40 years who underwent surgery between November 2021 and August 2025. All participants were followed up for at least 6 months. At the end of follow-up, mean penile length increased from 6.2 cm to 8.7 cm, and mean penile circumference increased from 9.4 cm to 11.2 cm, representing average gains of 2.5 cm in length and 1.8 cm in circumference.

Researchers also reported improvements in genital self-image and reduced distress related to penile size on the basis of validated psychosexual assessment scales.

Procedure Details

The penile girth augmentation technique, Dartos and Tunica Vaginalis flap (DART-VAG), is an entirely autologous surgical procedure that uses only the patient’s own tissue. It combines two tissues harvested from the scrotum: dartos fascia, located immediately beneath the scrotal skin, and the tunica vaginalis, which is the membrane surrounding the testes. These tissues are mobilized and wrapped around the penile shaft, creating an additional tissue layer that increases the penile circumference.

According to the authors, combining these two tissue flaps provides greater volume and improved vascularization of the surgical site, promotes tissue integration, and potentially provides more durable results than techniques that use fat grafts, fillers, or synthetic implants.

In addition to increasing the penile girth, the procedure releases structures that keep part of the penis retracted within the perineum, including the fundiform ligament. This allows a greater portion of the penis to protrude in the flaccid state, contributing to the increase in length observed in the study.

Speaking with Medscape’s Portuguese edition, “Many techniques use fat grafts, fillers, or synthetic materials that may be reabsorbed over time or require repeat procedures. DART-VAG was developed as an autologous, more anatomically based, and potentially more durable alternative by using the patient’s own well-vascularized tissue,” Barroso said.

He explained that although the primary goal of the procedure is to increase penile girth, releasing the perineal tissues also contributes to a greater flaccid penile length.

“We release the tissues that keep part of the penis embedded within the perineal region, including the fundiform ligament. This allows us to increase not only penile girth but also flaccid penile length,” Barroso said.

Safety Profile

No major intraoperative complications were reported during follow-up. Four patients (12.5%) developed partial wound dehiscence, which was managed with local wound care and specialist follow-up. Only one patient required surgical drainage for a scrotal hematoma.

The researchers also reported no impairment in erectile function, penile sensation, or sexual function.

According to Barroso, the decision to perform surgery requires careful evaluation of the patient.

“Genital cosmetic surgery should be offered only to patients with realistic expectations and an appropriate psychological evaluation. It is not simply an anatomical issue but also one of emotional and psychosexual well-being,” he said.

Despite these favorable findings, Barroso emphasized that this study represents an initial clinical experience.

“The publication of this study marks an important milestone for Brazilian reconstructive surgery. It now allows other groups to study, reproduce, and compare techniques. However, multicenter studies involving larger patient populations and longer follow-up are still needed to confirm the durability of the results.”

Independent View

Tiago Elisa Rosito, MD, PhD, coordinator of the Department of Gender Affirming Surgery and Genital Aesthetic Surgery at the Brazilian Society of Urology, who was not involved in the study, said the publication represents an important contribution to a field in which high-quality evidence remains limited.

“The Brazilian Society of Urology welcomes important publications by Brazilian researchers. This technique joins numerous internationally recognized contributions from Brazilian urology and highlights the leadership of our specialty,” Rosito said.

Although he described the findings as encouraging, he cautioned against overinterpreting the results.

“The results are very encouraging from both clinical and statistical perspectives. Even so, they should be interpreted cautiously because of the study design, the relatively small number of participants, and the duration of follow-up,” he said.

Rosito noted that all participants had an anatomy of a penis that was within the “normal range,” and that the primary benefits observed were improvements in self-esteem and quality of life.

“The primary indication for this technique is penile girth augmentation in men who are dissatisfied with penile thickness. The procedure is primarily intended for cosmetic purposes and to improve the patient’s self-image. Its effects on sexual function will need to be evaluated in future studies,” he said.

The researchers concluded that the DART-VAG technique appears to be a promising autologous approach for permanent penile girth augmentation. However, they emphasized that larger multicenter studies with longer follow-up are needed to confirm the procedure’s safety, effectiveness, and long-term durability before it can be adopted more widely in clinical practice.

Roseane Santos is a Brazilian journalist with 35 years of experience who has worked for major national outlets such as Universo Online, the daily newspaper Folha de S.Paulo, and Portal Terra and contributes to scientific publications from Albert Einstein Israelite Hospital and Brazil’s National Cancer Institute.

This story was translated from Medscape’s Portuguese edition.