Penuma Complications and Non-Surgical Alternatives

Dr. Luis Casavantes | Dr. Palmira Morales
Avanti Derma, Tijuana, Mexico

Penuma is a subcutaneous silicone implant designed to augment penile girth surgically. It has been in clinical use since 2004 and has undergone multiple design iterations. It is one of a small number of surgical options for penile augmentation, and patients considering it — or considering removal — deserve a clear-eyed clinical discussion of what the current literature shows.

What the Published Data Show

The published data on Penuma report reasonable satisfaction rates in appropriately selected patients, alongside a complication profile that is not negligible. Reported complications in the peer-reviewed literature include seroma, infection, device migration, wound dehiscence, chronic pain, and — in a subset of cases — the need for device explant.

Explant rates vary across published series but are consistently non-zero. This is a surgical implant, and surgical implants in this anatomy carry the risks that surgical implants carry.

Why Patients Seek Removal

Patients present for Penuma removal for several reasons:

• Persistent discomfort or chronic pain.

• Device migration or palpable irregularity.

• Cosmetic dissatisfaction with the result.

• Recurrent infection.

• Change in preference away from a surgical solution.

Removal is a defined surgical procedure with its own recovery. The tissue after explant may or may not return to a pre-implant state, depending on the duration of the implant, the extent of any capsular changes, and the individual healing profile.

The Non-Surgical Alternative Path

For patients who want girth enhancement without a subcutaneous implant, three non-surgical options exist. Our full comparison of HA, PMMA and Ellansé covers them in detail; in brief:

• HA fillers (Urofill or generic HA protocols): temporary, reversible, 9–14 months of duration.

• Biostimulatory fillers (Ellansé): 12–36 months, stimulates the patient's own collagen.

• PMMA-based fillers: permanent scaffold, lifelong result.

Non-surgical enhancement does not require an implant, does not require general anesthesia, and is performed as an outpatient procedure with local anesthesia. It carries its own risk profile — every intervention does — but the risks and management pathways differ meaningfully from those of a surgical implant.

After Explant

Patients who have had a Penuma explanted are, in principle, candidates for non-surgical girth enhancement once tissue healing is complete. The clinical evaluation is more nuanced than for a filler-naive patient — the surgical bed, capsular tissue, and any residual scarring change the anatomy — but the option exists.

We evaluate post-explant patients on a case-by-case basis at our clinic in Tijuana, typically no earlier than 6–12 months after removal, once tissue remodeling has stabilized.

The Selection Question

The decision between a surgical implant and a non-surgical filler is not a technical comparison. It is a decision about permanence, reversibility, tolerance for surgical risk, and desired outcome profile. A well-selected Penuma patient can have a good outcome. A poorly selected one can spend years managing a complication. The same is true for filler patients. The consultation is where the selection is done — or not.

Clinical Takeaways

• Penuma is a surgical implant with a documented complication profile in the peer-reviewed literature.

• Explant is a defined procedure with its own recovery; post-explant tissue may not return to pre-implant baseline.

• Non-surgical enhancement (HA, Ellansé, PMMA) exists as an alternative pathway with a different risk profile.

• Post-explant patients can often be evaluated for non-surgical enhancement 6–12 months after removal.

• The decision between surgical and non-surgical is a clinical one, made in consultation, not a marketing one.

Bibliography

1. Elist, J.J., et al. "Patient Selection Protocol for the Penuma Implant." Int J Impot Res 33 (2021): 201–207.

2. Elist, J.J., Valenzuela, R., Hillelsohn, J., Feng, T., Hosseini, A. "A Single-Surgeon Retrospective Review of Penile Enhancement Surgery With Silicone Implants." Aesthet Surg J (2018).

3. Manfredi, C., et al. "Penile Enhancement: A Comprehensive and Current Perspective." Current Urology (2024). PMC12076428.

4. Casavantes, L. Girth Matters. Avanti Derma, 2022.