An Innovative Penile Enlargement Approach: The Hardrock Sandwich Technique

Z. Sertkaya, A. T. Albayrak, Y. Başağa, D. Sökmen

Bovine Pericardial Graft, Penile Augmentation, Penile Enlargement, Penile Aesthetics

The video demonstrates the Hardrock Sandwich Technique (HST), a novel penile enlargement procedure combining two layers of bovine pericardial patch (Tutopatch®, AsyaMed, Turkey) with autologous plasma gel created via the TDD-4MC Plasma (PPP) Biofiller Gel Maker (Drawell International Technology Limited, China). Grafts are tailored intraoperatively according to penile dimensions, with plasma gel volumes ranging from 40–50 mL derived from 24 mL of patient blood.

The surgical approach begins with a reverse V incision 2–3 cm above the penile base under general anesthesia. Subcutaneous dissection proceeds to Buck’s fascia, followed by reverse degloving through combined blunt and sharp dissection between dartos and Buck’s fascia. This enables subdermal access to the glans via penile intussusception. The graft is secured distally at the coronal sulcus. To enhance stability, the suspensory ligament is dissected, and a quarter of a silicone testicular prosthesis (T-XLarge, Promedon, Turkey) is anchored to the pubic bone with absorbable 2-0 Vicryl® sutures, serving as a spacer and bridge.

Following meticulous hemostasis and dissection, the graft is affixed to the tunica albuginea with absorbable 4-0 Vicryl® sutures. The dartos and Buck’s fasciae are reapproximated, and the penile skin is advanced over the graft with a proximal V-Y plasty. Intraoperative irrigation with rifampicin solution is employed. A 10 Jackson-Pratt drain is inserted and removed once drainage falls below 20 mL/day. Patients are instructed to abstain from sexual activity, including masturbation, for at least six weeks or until cleared.

None.

The authors have nothing to disclose

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