In a recent prospective pilot study, a Brazilian surgical technique that uses a patient’s own tissue increased mean flaccid penile length by 2.5cm and penile circumference by 1.8cm while also improving genital self-image and reducing distress related to penile size, reports Medscape.
The study, published in the World Journal of Urology, describes, for the first time, a novel surgical technique for penile girth augmentation developed by urologist Ubirajara Barroso, Jr, MD, PhD, at the Federal University of Bahia, Salvador, Brazil.
The prospective, interventional, non-randomised study included 32 adult men with a mean age of 40 who underwent surgery between November 2021 and August 2025. All participants were followed up for at least six months.
At the end of follow-up, mean penile length increased from 6.2cm to 8.7cm, and mean penile circumference increased from 9.4cm to 11.2cm, representing average gains of 2.5cm in length and 1.8cm 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.
The penile girth augmentation technique, Dartos and Tunica Vaginalis flap (DART-VAG), is an entirely autologous surgical procedure using 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 mobilised 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 vascularisation 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.
“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-vascularised tissue,” Barroso said.
He added 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.”
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 haematoma.
The researchers also reported no impairment in erectile function, penile sensation, or sexual function.
Barroso said 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.”
Despite these favourable findings, Barroso emphasised 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, multicentre 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, co-ordinator 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.
Although he described the findings as encouraging, he cautioned against over-interpreting them.
“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 reiterated that larger 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.
Study details
DART-VAG: initial clinical experience with a novel autologous technique for penile girth augmentation
Ubirajara Barroso Jr, Isabela Barroso, Geraldo Filho et al.
Published in World Journal of Urology on 31 May 2026
Abstract
Purpose
Dissatisfaction with penile girth is an increasingly recognised concern among men and can cause psychosocial distress despite normal anatomy. Existing augmentation techniques are often associated with limited durability or procedure-related morbidity. This study presents the initial clinical experience with a novel autologous penile girth augmentation technique that combines dartos fascia and tunica vaginalis flap (DART-VAG).
Methods
This was a prospective, non-randomised interventional study evaluating the DART-VAG technique. Penile length and circumference were measured preoperatively and at a 6-month follow-up. Psychosexual outcomes were assessed in a subset of patients using the Degree of Distress due to size concerns (DDC) questionnaire and the Male Genital Self-Image Scale (MGSIS). Postoperative complications and patient satisfaction were prospectively recorded.
Results
Thirty-two adult men underwent penile girth augmentation with DART-VAG between November 2021 and August 2025. No intraoperative complications occurred. Mean penile length increased from 6.2 ± 1.67 cm to 8.7 ± 1.46 cm (p < 0.001), and mean circumference increased from 9.4 ± 1.08 cm to 11.2 ± 1.15 cm (p < 0.001). No patient reported loss of achieved dimensions, and all patients (100%) reported satisfaction at 6 months. Wound dehiscence occurred in four patients (12.5%), most of whom were managed conservatively; one patient (3.1%) required surgical drainage of a scrotal hematoma. Total DDC scores decreased significantly after surgery, and MGSIS improved in specific domains.
Conclusions
DART-VAG is a feasible technique for penile girth augmentation, providing significant gains, acceptable complications, and favourable psychosexual outcomes. Larger studies with longer follow-up are needed to confirm our findings.
Medscape article – Penile Enlargement Surgery: Can Size Improvements Last? (Open access)
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