Superior penile girth retention with stromal vascular fraction-enriched autologous fat grafting: a retrospective 1-year comparative study

Background: Fat resorption limits long-term outcomes of fat grafting for penile girth augmentation. Stromal vascular fraction (SVF)-enriched fat may improve graft survival by promoting angiogenesis, modulating inflammation, and via other paracrine effects. To our knowledge, no prior studies employed SVF for penile aesthetic procedures. In this retrospective non-randomized study, we aimed to assess the safety and clinical performance of SVF-enriched fat grafting versus Coleman fat.

Methods: For the treatment group (n=50), protocol key steps included liposuction, non-enzymatic extraction of SVF via a novel device, fat enrichment, and graft injection, avoiding the corpora cavernosa. The Coleman fat group (n=38) received conventional grafting. Penile girth and length (flaccid and erect) and International Index of Erectile Function-5 scores were evaluated at baseline and at 1, 3, 6, and 12 months. Satisfaction was recorded at 12 months. Men with mild erectile dysfunction (n=10 and n=17 in the Coleman fat and treatment groups, respectively) also completed the full questionnaire about erection. The primary outcome was change in penile girth. Exploratory outcomes included change in penile length, erectile function, and patient-reported satisfaction with the procedure.

Results: At 12 months, the treatment group showed significantly higher volume retention across all measurements (P<0.001), greater satisfaction (4.2/5 versus 3.7/5; P=0.01), and improvement of erection in mild erectile dysfunction cases (P=0.002). Changes were as follows (treatment versus Coleman fat, mean in centimeters): flaccid girth: +2.8 versus +1.6; erect girth: +1.9 versus +1.0; flaccid length: +1.0 versus +0.6; erect length: +0.8 versus +0.4. Two patients in each group had minor wound infections.

Conclusions: SVF-enriched penile fat grafting improved volume retention with favourable functional outcomes in mild erectile dysfunction, supporting the feasibility of this approach in the penile setting.