Dr. Jack McAninch likes to perform his surgeries shortly after dawn -- "Get in and get it done," as he says. Besides, by the time they meet on the operating table, McAninch and patient have talked about the surgery so much that the procedure itself seems almost anticlimactic.
They're a difficult bunch, his patients. It's not easy for them to re-enter the deep sleep of anesthesia and allow someone to take a knife to their penis ... again. And regardless of McAninch's level of success, they will not likely be happy.
The only hint that McAninch is 60 years old is a slight stoop and well-worn facial creases, badges for years of intense operating room service. He eyes his patient on the table through what amounts to a giant magnifying glass strapped to his head. The patient's groin area on the table is freshly shaven, offering McAninch the first real look at the task at hand. McAninch and two assistants, who are in for a learning experience, re-evaluate their original plan, their voices filtered through cotton masks.
This patient's penis has been cruelly deformed. Just above the glans, the shaft buckles out into what looks like a knuckle, the gnarly section the resting place of a wad of fat that was sucked out of the patient's abdomen and injected through a needle into his penis. Where the shaft connects to the torso is a lump of tissue that resembles a fleshy doughnut. And above the genitals is a jagged scar that looks like an upside-down Y running up the pelvis.
The doctor's diagnosis: "A pretty grotesque-looking arrangement."
It's an "iatrogenic" condition -- a medical affliction caused by another doctor working on another operating table. McAninch's job is to give the patient back his normalcy.
"This is sort of a sow's ear here, and they want me to make a purse out of it," he says.
McAninch takes a marking pen and begins to draw what will likely be a road map through the scar that's been left from the previous incision. If it works, which is likely, the scar will vanish.
His highly skilled hands, directed by of one of the most knowledgeable brains in the field of urology, takes up a scalpel and addresses the brutality that man has inflicted onto Mother Nature's creation.
The inherent quest for something bigger has paired with man's constant dissatisfaction with the human anatomy to give rise to "penile augmentation surgery."
Each year, hundreds of normal-size men plop down close to $6,000 for the promise of a longer and thicker penis. It's the same vanity that drives the multibillion-dollar field of plastic surgery -- the nipping, tucking, sucking out, lifting, and implanting business. Advertisements for penile augmentation in men's magazines and in the sports pages proclaim that "No man ever needs to feel inadequate again." Internet sites provide information on a caboodle of contraptions and processes for lengthening, strengthening, and puffing up. Free consultations are only an 800 number away.
Although penis augmentation is considered experimental surgery by every major medical association in the country, a number of doctors across the nation perform the procedure. Over the past five years, one Los Angeles physician has surgically amplified more than 5,000 penises.
That figure seriously ruffles the generally unflappable McAninch, because during the last two years, he's had to see more than 20 cases where augmentation created physiological horror.
"I think what I see is the very tip of the iceberg," he says. "My guess is that 80 or 90 percent of the patients are unhappy with what they got. Most of them are living with it. They don't want anybody to know that they got it done."
In 30 years of practice, McAninch has applied his talents to every kind of human plumbing problem -- tumors, cysts, ruptured bladders, crushed pelvises, all manner of prostate problems, and injuries galore. But he's never seen anything like the current wave of botched penis jobs.
Certainly, there are some satisfied, enlarged customers. But when penis surgery goes bad, it goes really bad, leaving behind a wake of anatomical abominations: jagged scars scrawled up the pelvis; shafts that are crooked, lumpy, and grotesquely deformed; infected wounds; hard, marblelike bumps; internal scarring so severe that sexual intercourse is painful; erections that point downward; penises left hanging between the testes; rolls of skin and hair at the base of the shaft; raw nerves caught in scar tissue; and fluid that chronically collects around the testicles. And those are just the visible wounds. The psychological scars on men who were desperately seeking attention, approval, and self-esteem and wound up mutilated don't show.
Last June, a Florida jury convicted cosmetic surgeon Ricardo Samitier Jr. of manslaughter after a penile enlargement patient bled to death in his clinic. In February, an administrative law judge, acting on the recommendation of the Medical Board of California, suspended Los Angeles urologist Melvyn Rosenstein, the largest practitioner of augmentation surgery in the country, for gross negligence, false advertising, and failing to physically examine and disclose the risks of surgery to his patients.
But while the number of enhancements may be declining, the repair business is only beginning.
McAninch and his colleagues at the University of California at San Francisco completed a study last year that statistically calculated normal penis size at 3.5 inches when flaccid and 5.1 inches when erect. The researchers determined that only 2 percent of all men had penises that were "subnormal" and might qualify for the procedure. The unfortunate few whose penises are less than 2.8 inches when erect may suffer from something called "microphallus," usually from congenital defect or accident.
How you measure is critical. The researchers found that some normally endowed men only appear to be small because of thick layers of fat -- up to 3 inches -- over the pubic bone. Rosenstein adds that most of the patients submitting to penile augmentation surgery were OK to begin with.