Medical report Prof. Dr. Gottfried Lemperle regarding PeniMaster®PRO

The use of PeniMaster Pro in penis length enlargement and penis enlargement surgeries.

During my time as a plastic surgeon at the Markus- Krankenhaus (Markus- Hospital) in Frankfurt from1971 to 1994 we established a transgender- center focused primarily on phallic constructions in female transgender patients. Within the subsequent period at the University of California in San Diego I was confronted with the issues regarding penis enlargement by the means of tubular silicone implants (Elist Penile Implant) in Los Angeles or by the means of subcutaneous injection into the penis skin with a Brazilian filling material used in cosmetic surgery (Metacrill) developed by Dr.Casavantes in Tijuana.

In particular in the event of complications I represent the point of view that the use of a penis extender; this is an external device, by which the penis can be stretched for a longer period of time, is useful when aiming at improvement of the surgical results. For example; penis stretching exercises lasting several hours a day within a period of several months lead to a considerable "relaxation" of the tissue. Consequently; the penis preserves -up to the point of the surgery - its maximum natural length; in this way the biggest possible silicone-implant can be used. As a rule this is what the patients do expect.

The results within a cohort of 400 patients of Dr. Elist also showed (see my lecture 'Penis enlargement by the means of the Elist-Silikon- Implant or a permanent PMMA- filler') that in 3,4% of the cases the silicone implant led to inflammations, so that the implant had to be removed in 2 % of males for at least three weeks. Within this period the penis considerably shrinks as a result of wound healing (tissue repair) reactions and capsular shrinkage and thus the organ can only hardly be stretched again with an implant of the same size through a subsequent adjustment correction. Wearing the extender within this period considerably prevents the ‘retreating’ of the penis and produces almost as good second -ary effect.

Also; the extender protects after the injection of PMMA- filler unwanted unevenness as well as displacements due to ast possible immobilization in extended position until the micro implants are fastened hefty in the sheath area. Through the interaction with drugs used for prevention of nocturnal penile tumescence (Clonazepam 1 mg or Proscar 5 mg in the evening) the extender holds the penis in a stretched position in a constant length and reduces this concern. For the use of a penis extender in the described application areas there are no alternatives. However; in order to be adapted for the advance care and after-care it is necessary that the extender has a high wearing comfort so that it could be applied long enough. Extenders, which exert traction force by the means of levers (rods), belt system or weights on the penis are usually fastened through a rubber constriction loop placed behind the glans. (penis). It is noteworthy to mention that the penis can painfully be bruised and that the blood supply to the glans penis can be therefore reduced. Both things have consequences for use of such an extender after a relatively short therapy period.

After inserting the Elist silicone- implants into the penis an extender cannot principally be fastened due to its subcutaneous placement below the glans by the means of loop fixation (immobilization). The only extender used at present, which solely uses the glans for transferring the traction force to the penis is equipped - instead of a loop with a suction bell looking like a condom AND serving as a contact system. In order to make glans bells of such kind exert a possibly slight vacuum pressure on the sensitive skin of the penis it is advisable that the special glans condom of an anatomical form of the glans penis is properly matched (this is; properly fits), which allows a physiologically protective, force-fitted fixation without over-expanding of the glans or its being deformed. Feeling pain while wearing it or adverse effects such as cystic changes (bruises) within the glans result in a temporary discontinuation of the penile traction therapy (PTT).

Hanswjacob, CC BY-SA 4.0, via Wikimedia Commons

Curriculum vitae Prof. Dr. Gottfried Lemperle

An authority on plastic surgery, Prof. Dr. Gottfried Lemperle has contributed greatly to the field medicine. He has written more than 250 scientific publications and co-authored several books, in addition to serving as an editor for a number of textbooks on plastic and aesthetic surgery. Dr. Lemperle has also conducted more than 600 scientific presentations and directed 12 scientific films and videos about new operation methods in plastic surgery. For more than 20 years, Dr. Lemperle was a professor at the University of Frankfurt in Germany, and he has held the role of Voluntary Clinical Professor at the University of California, San Diego, since 1998.

Awarded with the Dieffenbach Medal by the German Society of Plastic, Reconstructive, and Aesthetic Surgeons in 2010, Dr. Gottfried Lemperle has made outstanding achievements in plastic surgery. While teaching at the University of Frankfurt and concurrently operating as Chief Resident and then Chief of the Department of Plastic Surgery at the St. Markus Hospital, Dr. Lemperle contributed a variety of operational strategies to the field. His innovations include breast reconstruction techniques and correction of facial malformations like cleft palate, among other advancements in plastic surgery.

In Germany he was voted one of the country's top plastic surgery specialists and is the author of several books and scientific journal articles on plastic surgery.

In 1979, Dr. Gottfried Lemperle founded Interplast Germany e.V, a non-profit that performs free plastic surgery for selected patients in developing nations who suffer from conditions that can be corrected through surgery. Since that time, Dr. Lemperle has completed over 30 Interplast missions in several countries throughout Asia and Africa. He is an honorary member of the organization and continues to volunteer his services. 1997 Prof. Lemperle was honoured with the German Bundesverdienstkreuz 1. Klasse (Federal cross of merit)

Also involved in the industry of aesthetic biotechnology, Dr. Gottfried Lemperle serves as Chief Medical Officer of AscentX Medical, Inc., and Chief Medical Advisor of Hafod Bioscience B.V. He also serves as an honorary member of the Chinese Plastic Aesthetic Surgery Research Board.

Dr. Lemperle lives with his wife in Frankfurt/Main, Germany.

Prof. Dr. Gottfried Lemperle on penis surgery and PeniMaster PRO

The use of PeniMaster Pro in penis length enlargement and penis enlargement surgeries.

Among the products I know and which are offered at congresses or on the Internet, there is only one device meeting the criteria mentioned above; this is the PeniMaster PRO, which is manufactured by the company MSP Concept GmbH (Ltd.) & Co. KG in Berlin/Germany and which is offered as a medical device - class I.

The anatomically fully formed glans fixation can be used with a linkage or with a differently worn belt intended for penis stretching. The belt system seems at first sight to be more flexible; however; the linkage shall not be worn in such a rigid way as it is likely to be worn. Though, the linkage can be used not earlier than two up to three weeks after performing penis length enlargement surgeries since the holding ring would exert pressure on the fresh scar tissue which can be observed after separation of the holding bands of the of the penis (suspensors).

Principally a penis extender is beneficial in the case of such length surgical procedures which aim at avoiding the shortening of the penis caused by scar tissue. Is that the case, a beneficial option is to wear the extender as a knee strap (vertically down to the bottom) or as a diagonal shoulder belt

Bell extenders can cause swelling of the foreskin if they are pulled together into the chamber. In addition; they can cause bruises or haematoma (blood effusion) on the glans penis. This kind of problems generally occur when the patient needlessly uses large vacuum or traction forces which can activate the system without the patient being familiar with such situations. However; this can be avoided by the use of an adaptive membrane, which automatically 'surrounds' the chamber when absorbed. Despite this; step by step the patient should and is supposed to get used within a period of circa two weeks to the penile traction therapy (PTT) as well as to higher traction forces.

When using the PeniMaster PRO System it is an important thing to emphasize that the afore-said glans penis membrane could dynamically fit while being worn and that there should be no situation where it would slide off due to accumulation of moisture (like sweat). Here we can see that -as a matter of fact -the tight fit and not the force fit between glans penis and glans chamber make the difference. Otherwise it is foreseen to use a middle- viscous silicone oil placed between the membrane and glans penis for more comfort and achieving additional adhesive binding force.

Since the adverse effects when using the PeniMaster PRO can easily be avoided through proper handling according to the usage instructions and since there is a quick healing up process during the pause period I consider the risk-benefit ratio in the case of this innovative device as being proper and I recommend it for the preoperative as well as postoperative use as the only possibility and option I have known till the present day.

References

1. Nabil N, Hosny H, Kadah A, Shamloul R. Evaluation of surgical outcome of penile augmentation and lengthening procedures. Urol Int. 2013;90:465-469
2. Shirvanian V, Lemperle G, Araujo Pinto C, Elist JJ. Shortened penis post penile prosthesis implantation treated with subcutaneous soft silicone penile implant: case report. Int J Impot Res 2013;10:100-104
3. Elist, JJ, Shirvanian V, Lemperle G. Surgical treatment of penile deformity due to curvature using a subcutaneous soft silicone implant: Case report. Open J Urol 2014;4:91-97
4. Casavantes L, Lemperle G, Morales P. Penile Girth Enhancement with PMMA-based soft tissue fillers. Accepted by the Journal of Sexual Medicine
5. Lemperle G, Elist JJ, Safety and Effectiveness of the Elist-Silicone-Implant for Penile Augmentation. Submitted to the Journal of Sexual Medicine

Prof. Dr. Gottfried Lemperle
Plastischer Chirurg
Frankfurt am Main

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