Ligamentotomy & the Suspensory Ligament

Anatomy: The Suspensory Ligament

The suspensory ligament – in Latin, the ligamentum suspensorium penis – is a taut, fibrous ligament that runs downward from the front of the pubic bone (os pubis, symphysis) and anchors at the base of the penis. It lies beneath the skin and is not visible from the outside. Together with the deeper fundiform ligament, it forms the connective-tissue support structure of the penis, which provides stability in everyday activities – walking, sitting, or physical exertion – and fixes the penis at a defined angle. During erection, the suspensory ligament helps stabilize the erect penis, but it is not itself involved in producing the erection.

Anatomically significant is the fact that a substantial portion of the erectile tissue – and thus of the functional length of the penis – lies inside the body and is held back by this ligamentous apparatus. It is this internal portion that can be mobilized and shifted outward through ligamentotomy.

What Is a Ligamentotomy?

The term derives from the Latin ligamentum (ligament) and -tomy (cutting). Ligamentotomy thus refers to the surgical severing of the suspensory ligament with the aim of shifting the internal portion of the penis outward and thereby lengthening its visible portion. No new tissue is added in the process – instead, existing tissue is simply repositioned.

Surgical Procedure

The procedure is performed through a small skin incision in the pubic area, through which the suspensory ligament is located and deliberately severed. The penis is then fixed in its new, more externally positioned location – using special suturing techniques or other surgical measures – to prevent the ligament tissue from reattaching. The operation is usually carried out under gentle twilight sedation and, depending on whether it is combined with other measures, takes about one to two hours.

Aftercare

Postoperative aftercare is crucial to long-term success. Rest and consistent wound care are required in the first few weeks. To secure the achieved result and prevent the ligament tissue from reattaching, regular use of a penis extender – a specialized stretching device – is recommended. Compliance with aftercare is one of the key factors influencing the individual lengthening effect.

Risks and Limits

Ligamentotomy is a well-established procedure, but like any surgical intervention it carries specific risks. The most common functional change is a lowering of the erection angle: since the ligament stabilizes the penis in its upright position, the penis may stand somewhat flatter – angled more downward – during erection once the ligament has been severed. This phenomenon is well known and should be discussed during the consultation. Other possible risks include scarring in the pubic area, incomplete fixation with a partial recurrence of the lengthening effect (risk of relapse), and general surgical risks such as infection or delayed wound healing. Individual anatomy places natural limits on the achievable lengthening, which cannot be fully predicted before surgery.

Combination with Lipofilling

At our center, ligamentotomy is frequently combined with autologous fat transfer (lipofilling). While ligamentotomy increases the length of the visible portion of the penis, lipofilling adds to its girth. Combining both procedures allows for a more harmonious overall result, since an isolated lengthening without corresponding thickening can look visually unbalanced. Whether a combined treatment makes sense is determined individually during the consultation.