(075) Impact of Preoperative Dysmorphic Concerns on Postoperative Genital Self-Image and Satisfaction After the “Iron Man” Phalloplasty Protocol

Introduction Concerns regarding penile size and appearance may lead some men to seek cosmetic genital surgery for improved confidence, sexual function, or self-esteem. However, the psychological profile of these patients is heterogeneous, and underlying body dysmorphic traits can markedly influence postoperative satisfaction. The Cosmetic Procedure Screening for Penile Dysmorphic Disorder (COPS-P) is a validated scale designed to detect penile dysmorphic disorder (PDD) independent of actual penile dimensions (Veale et al., 2015). The Male Genital Self-Image Scale (MGSIS) measures the subjective perception of genital appearance and satisfaction. Psychometric evaluation combined with objective outcome measures provides a more complete understanding of satisfaction after penile enlargement. Objective To evaluate the relationship between preoperative COPS-P scores and postoperative changes in MGSIS among men undergoing the “Iron Man” phalloplasty protocol, and to determine how psychological and anatomical parameters jointly influence postoperative outcomes. Methods A retrospective analysis of 194 male patients who underwent the Iron Man protocol a novel combined phalloplasty approach defined by the author team was performed. The technique includes abdominal and pubic liposuction, suspensory ligament release, and autologous penile fat grafting using purified adipose tissue harvested during liposuction. Circumcision and/or scrotal webbing excision were added when indicated. All procedures were performed by the same surgical team under standardized anesthesia and aseptic conditions. Demographic variables (age, body mass index [BMI]), pre- and postoperative penile length and circumference, injected fat volume, fat retention percentage, and postoperative complications were documented. Preoperative COPS-P scores were classified as <40 (no suspicion of PDD) or ≥40 (suspected PDD). MGSIS was administered pre- and postoperatively, and ΔMGSIS (post − pre) represented the change in genital self-image. Correlations were assessed using Spearman’s rho, and group comparisons with independent-sample t-tests (p < 0.05 significant). The study protocol was approved by the Institutional Review Board, and all procedures complied with the Declaration of Helsinki. Results The mean preoperative COPS-P score was 31.8 ± 11.6, with 27.3% of patients scoring ≥40. Mean penile length increase was 2.3 cm (p < 0.001) and circumference gain 2.0 cm (p < 0.001). The mean MGSIS improvement was 5.0 ± 3.6 points. Patients with COPS-P ≥40 showed significantly smaller MGSIS improvement (3.0 ± 2.7 vs. 5.9 ± 3.1, p < 0.001). Preoperative COPS-P correlated negatively with ΔMGSIS (r = −0.41, p < 0.001) but not with size gain (r = −0.09, p = 0.20). Fat retention correlated moderately with satisfaction (r = 0.29, p = 0.03). Postoperative complications occurred in 9.2% of cases and were associated with lower MGSIS scores (p = 0.02). Conclusions High preoperative dysmorphic concerns, reflected by elevated COPS-P scores, predict limited postoperative improvement in genital self-image, irrespective of objective enlargement. The Iron Man protocol a newly defined surgical concept combining ligament release and autologous fat grafting provides comprehensive aesthetic and functional enhancement. Incorporating psychometric screening tools such as COPS-P and MGSIS into preoperative assessment may refine patient selection, improve counselling, and enhance satisfaction and outcomes in aesthetic penile surgery. Disclosure No