A “buried” penis refers to a penile shaft buried below the surface of the pubic skin and also to a partially or totally obscured penis caused by obesity or an overly aggressive circumcision. 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 a lipoma of each spermatic cord, hides the penis from view. The penile skin drapes over the penile shaft, giving the appearance of redundant skin overlying the head of the penis with concealed erectile bodies. 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. The incision line constricts upon healing, burying the penis by pushing it downward into the pubic fat. Frequently, a secondary circumcision may be incorrectly performed on patients with various causes of concealment. This may prevent repair that requires the remaining penile or preputial skin and instead necessitates a skin graft.
Infants with buried penis are often told that they will outgrow the abnormality as they age especially during adolescence. Many of these boys will improve with growth, but some will never achieve the visual or functional length possible (see category of Hidden Penis under Penile Enlargement). The patient with severe buried penis may be ridiculed by other boys, causing feelings of inadequacy. These boys may have no visible penis while standing and may have to sit to urinate.
The surgical correction of a buried penis depends on the abnormality. However, marked improvement can be achieved in most patients by excising excessive pubic fat and suturing down the overlying skin of the pubis and scrotum to the erectile bodies. Rarely, skin grafts are necessary if too much skin was removed by a previously radical circumcision. (FIGURE 1 & 2)
If you have any questions about buried penis surgery please feel free to contact Board Certified Plastic Surgeon, Board Certified Urologist Dr. Gary Alter at his Manhattan, New York or Beverly Hills, California office.