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A retrospective evaluation of the safety and effectiveness of an innovative penile enlargement approach: the Hardrock Sandwich Technique

International Journal of Impotence Research (2025)Cite this article

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Abstract

Penile enlargement procedures have become increasingly popular for aesthetic and psychological reasons. While traditional enlargement techniques, such as fat grafting, hyaluronic acid fillers, and silicone implants, have varying degrees of success, they also present risks such as infection, migration, and resorption. The Hardrock Sandwich Technique (HST) combines bovine pericardial grafts with autologous plasma gel to enhance penile girth and incorporates suspensory ligament release with testicular prosthesis placement for length increase. However, data on the technique’s long-term safety, effectiveness, and patient satisfaction remain limited. This study evaluates the safety, effectiveness, and patient satisfaction of HST use in elective penile enlargement surgery. It focuses on postoperative changes in penile dimensions, self-confidence, self-esteem, and complications over a period of at least one year after surgery. This retrospective, single-center study included 456 male patients who underwent the HST between April 2022 and September 2024, with at least one year of follow-up. Penile girth and length were measured preoperatively and on the 1st day, 3rd month, and 12th month after the operation. Patient satisfaction, self-confidence, and self-esteem were assessed using the Augmentation Phalloplasty Patient Selection and Satisfaction Inventory. Postoperative complications were recorded. On the first postoperative day, mean penile girth increased by 43.13% (4.51 ± 2.17 cm, p < 0.001), and penile length increased by 20.78% (2.17 ± 2.53 cm, p < 0.001). A total of 83.40, 71.10, and 75.30% of the patients reported improvements in satisfaction, self-confidence, and self-esteem, respectively, one year after the operation. Postoperative complications included seroma (6.12%), wound dehiscence (2.34%), infection (2.65%), and hematoma (1.40%). One patient had skin necrosis (0.22%), which required the graft to be removed. None of the patients experienced erectile dysfunction or ejaculation issues. The HST is a promising approach for penile augmentation that offers significant improvements in girth, length, and patient satisfaction with minimal complications.

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Fig. 1: The bovine pericardial patch integrated with autologous plasma gel prepared intraoperatively for use in the Hardrock Sandwich Technique.
Fig. 2: The dimensions of the Hardrock Sandwich Graft.
Fig. 3: Reverse degloving of the penis following subdermal dissection, with the Hardrock Sandwich Graft positioned adjacent to the coronal sulcus.
Fig. 4
Fig. 5
Fig. 6
Fig. 7: The skin necrosis after Hardrock Sandwich implant.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Andro Expertise Men’s Health and Aesthetic Clinic, Andrology Department, Istanbul, Turkey

    Zülfü Sertkaya, Ahmet Tevfik Albayrak & Doğukan Sökmen

  2. Nişantaşı University, Urology Department, Istanbul, Turkey

    Yaşar Başağa

Authors
  1. Zülfü Sertkaya
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  2. Ahmet Tevfik Albayrak
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  4. Doğukan Sökmen
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Contributions

ZS designed experiments, DS designed experiments and helped to collect data, ATA collected data, performed the data analysis, and wrote the manuscript, YB contributed to data extraction and provided feedback on the report.

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Correspondence to Ahmet Tevfik Albayrak.

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Sertkaya, Z., Albayrak, A.T., Başağa, Y. et al. A retrospective evaluation of the safety and effectiveness of an innovative penile enlargement approach: the Hardrock Sandwich Technique. Int J Impot Res (2025). https://doi.org/10.1038/s41443-025-01172-w

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