Plaque Incision and Grafting Surgery

Plaque incision and grafting is a reconstructive operation used to correct significant penile deformity caused by Peyronie’s disease.

Peyronie’s disease produces fibrotic tissue within the tunica albuginea surrounding the erectile bodies of the penis. When the affected side loses elasticity, it cannot expand normally during erection, causing the penis to bend toward the shortened side.

Plaque incision and grafting addresses this shortened side directly.

The surgeon makes one or more controlled incisions through the restrictive tunica at the point of maximum curvature. Opening this tissue creates additional space and allows the shortened side to expand.

The resulting tunical defect is then covered with graft material.

The goal is to restore more symmetrical penile dimensions and achieve a functionally straight erection without deliberately shortening the longer side.

Who is plaque incision and grafting designed for?

This procedure is not appropriate for every patient with Peyronie’s disease.

It is generally considered when the patient has:

• Significant penile shortening

• Severe curvature

• Complex deformity

• Hourglass deformity

• Hinge deformity

• Adequate erectile function

Curvature above approximately 60 degrees is often considered severe in clinical practice, although the overall deformity and functional impact are more important than a single angle.

Why must Peyronie’s disease be stable before surgery?

Surgical reconstruction is generally performed during the stable phase of Peyronie’s disease.

Operating while the condition is still actively changing creates a risk that curvature or deformity will continue to progress after reconstruction.

The surgeon therefore evaluates whether:

• Curvature has stopped progressing

• Deformity has stabilized

• Pain associated with the active disease phase has resolved or stabilized

• The patient’s sexual difficulty remains significant

The exact duration of stability can vary, so candidacy should be based on clinical assessment rather than a calendar alone.

How is the operation performed?

Before or during surgery, the surgeon evaluates the erect penis to define the direction, degree and complexity of the deformity.

An artificial erection is commonly created during the operation.

The surgeon identifies the concave or shortened side at the point of maximum curvature.

Depending on the location of the deformity, neurovascular structures may need to be carefully mobilized.

One or more incisions are then made through the restrictive tunica albuginea.

Opening the tunica creates a defect and allows the shortened side to expand.

A graft is cut to the required size and fixed over the defect.

Another artificial erection is then performed to assess the correction.

Additional maneuvers, including limited plication, may sometimes be required if meaningful residual curvature remains.

Is the Peyronie’s plaque removed?

Usually, complete plaque removal is not necessary.

Modern surgery commonly involves incision of the restrictive plaque or tunica, rather than total excision.

Complete plaque excision can increase the risk of postoperative erectile dysfunction because it may create a larger defect and greater disturbance of the tunica.

Partial excision may still be considered in selected situations, such as heavily calcified plaques.

What types of graft can be used?

Many graft materials have been used in Peyronie’s reconstruction.

Autografts

Tissue taken from the patient’s own body, such as:

• Buccal mucosa

• Saphenous vein

• Fascia

• Tunica vaginalis

Allografts

Human donor-derived tissue, including certain pericardial and fascial grafts.

Xenografts

Biological material derived from another species, such as:

• Bovine pericardium

• Porcine small intestinal submucosa

• Collagen-based materials

Different grafts have different handling characteristics, availability and evidence bases.

There is no single graft that is universally best for every patient.

What about buccal mucosa grafting?

Buccal mucosa is tissue harvested from the inside of the patient’s mouth.

It has become an important graft option in reconstructive Peyronie’s surgery because it is flexible, well vascularized and familiar to reconstructive urologists.

Published studies report high rates of straightening and patient satisfaction, but outcomes should not be generalized to all graft materials or all patients.

Plaque incision and grafting vs penile plication

This is one of the most important comparisons for patients.

Penile Plication Surgery corrects curvature by shortening the longer, convex side.

It is generally simpler and may carry a lower risk of postoperative erectile deterioration, but penile shortening is an important trade-off.

Plaque Incision and Grafting Surgery addresses the shorter, concave side.

It is generally considered when:

• Penile shortening is already significant

• Curvature is severe

• Deformity is complex

• Hourglass or hinge deformity is present

• Further shortening from plication would be undesirable

The trade-off is that grafting is more extensive surgery and carries a greater risk of postoperative erectile dysfunction.

Does grafting make the penis longer?

It should not be marketed as penile-lengthening surgery.

The purpose of tunical-lengthening surgery is to correct the deformity and reduce additional shortening.

Some patients may regain part of the functional length lost because of curvature, but long-term enlargement beyond the patient’s pre-disease anatomy should not be promised.

Plaque incision and grafting vs penile implant surgery

Erectile function is one of the main factors determining which procedure is appropriate.

A man with severe curvature and good erectile function may be a candidate for incision and grafting.

A man with Peyronie’s disease and severe erectile dysfunction that does not respond adequately to medication is generally better evaluated for penile prosthesis implantation, with additional curvature correction if required.

Why surgeon experience matters

Plaque incision and grafting is more technically demanding than straightforward plication.

The surgeon must manage:

• Penile neurovascular structures

• Tunical incision

• Graft sizing

• Graft fixation

• Curvature correction

• Erectile tissue preservation

• Complex three-dimensional deformity

For international patients, surgeon experience in reconstructive penile surgery is particularly important because the operation requires individualized planning rather than a standardized one-size-fits-all approach.