Buried / Hidden Penis

A “buried” penis refers to a penile shaft buried below the surface of the pubic skin and scrotum. The penis can be partially or totally obscured by obesity, aging with excess hanging skin, or pushed inside by a skin deficiency from an overly aggressive circumcision. (See category of Hidden Penis under Penis Enhancement Surgery) It is also referred to as a hidden or concealed penis. A true buried penis is a rare congenital anomaly that has two components; an abnormally large suprapubic fat pad and dense tissue that tethers and retracts the penis inward. The fat pad extends from the suprapubic region onto the scrotum, perineum, and medial thigh, and, combined with fat around each spermatic cord, hides the penis from view.

The penile skin drapes over the hidden penile shaft, giving the appearance of redundant skin overlying the head of the penis. Circumcision on an unrecognized buried penis can remove normal shaft skin instead of foreskin, thereby worsening the situation. In a normal infant, inadvertent removal of excess shaft skin during circumcision can leave a variable amount of foreskin. Since the foreskin is not well attached to the deeper penile structures, the penis tends to bury or hide. In addition, the incision line can constrict upon healing, further burying the penis by pushing it downward into the pubic fat. Frequently, a secondary circumcision is incorrectly performed on these patients in a mistaken attempt to make the penis more visible. Instead, the circumcision may make the concealment worse by causing a shortage of penile skin, thus necessitating the use of a skin graft to expose the shaft.

Infants with buried penis are often told that they will outgrow it, especially during adolescence. Many of these boys will improve with growth, but some will never achieve the visual or functional length possible. Other males may ridicule the patient with a buried penis, causing feelings of inadequacy. Some of these boys and men may have no visible penis while standing and may have to sit to urinate. The loss of self-esteem can lead them to refrain from school sports, locker room situations, or relationships. In addition, a chronic hidden or buried penis can result in chronic inflammation of the penile head and remaining penile skin due to persistent dampness from urine and sweat. The shaft skin can deteriorate further and necessitate a skin graft.

The surgical correction of a buried or hidden penis depends on the abnormality. Structurally, the underlying defect is usually a lack of attachments of the penile skin to the deeper penile structures, so the penis disappears into the pubic area and scrotum. The situation is worse if there is a large pubic fat pad or excess pubic skin. A thin patient may only need surgical stabilization of the penile skin to the penile shaft at the base of the penis. The overweight or aged patient can have marked improvement by removing excessive pubic skin and fat, suturing the pubic tissues to the underlying muscles, and stabilizing the pubic skin and scrotal skin to the deeper penile structures. Rarely, skin grafts are needed if there is inadequate skin from chronic inflammation or a previous radical circumcision.

The illustrations below show the surgical technique on boys who are overweight. If the boy is not overweight, the pubic incision and fat removal is unnecessary. Instead the penis is stabilized by a small incision at the junction of the penile skin and pubic fat.

Illustration 1

The typical patient with partial hidden or buried penis. The patient has a large pubic fat pad. The penis buries into the pubic fat and scrotal sack. The skin is not well attached to the underlying penile structures.

Illustration 2

An incision is made above the pubic fat pad. If extra skin is present, some is excised . Fat is removed by a combination of liposuction and excision. The pubic skin is sutured to the underlying muscle to prevent it from sliding down and to prevent the penis from going inside the fat. This stabilizes penile skin to the penile shaft.

Illustration 3

An incision is made at the junction of the penis and scrotal skin. Sutures are placed from just under the skin to stabilize the skin to the penile shaft. This prevents the penile shaft from burying into the scrotal sack.

Illustration 4

The patient at the end of the procedure. The pubic skin is anchored to the pubic muscles with pubic fat removed. The underside of the penis is anchored to skin at the junction of the penis and scrotum. The penoscrotal incision is closed with a zig-zag. Sometimes extra penoscrotal skin is removed.

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As a best in class plastic surgeon, Dr. Gary Alter provides highly personalized and comprehensive care. His philosophy regarding the physician / patient relationship is based on trust and has earned him one of the most respected reputations in the world.

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