Table 3 Information regarding the phalloplasty discussed with the patients during their general examination.

(a) The estimated results given by our centre (+1.5–4.0 length, +20–35% circumference) refer to an increase between a minimum and maximum obtained from a historic average of all the patients operated both for elongation and enlargement. The availability of a vast collection of pre- and post-surgical photographs shown during the general examination confirmed such variability;

(b) it is possible that an increase cannot be achieved following the procedure and the achievable increase in each case can only be partially foreseen and depends on 1) the consistency and especially the depth of the suspensory ligament which can be overall evaluated sonographically (evaluation of the penopubic space superficially) concerning the elongation of the penis; 2) subjective variables such as metabolism and lifestyle which can increase or accelerate the reabsorption of the implanted fat concerning the enlargement of the penis;

(c) the increase acquired in terms of length is markedly more visible in conditions of flaccidity than in erection, with a ratio of about 3:1;

(d) occasionally, implanted fat can be subject to excessive reabsorption during the first three months after surgery and, in that case, if the patient wishes, a new definite transplant can be performed;

(e) in enlargement phalloplasty, the different consistency between the fat and the cavernous bodies causes a change in the tactile consistency of the penis; along the shaft, such change is progressive so that no “steps” are felt, and there is no variation in the quality of the erection or local sensitivity;

(f) after an elongation procedure, a slight change in the angle of erection can occur, more marked if the increase is significant (10–15 degrees);

(g) exceptionally, nodularity can occur in the implanted fat; such nodularity is, however, transitory and almost always resolves spontaneously.