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Explants can be done via a circumcising incision and degloving, however we recommend a penile inversion approach to best access the distal implant tacking sutures.31 Although some authors report good results following explant and penile rehab,27,29 our group has described a case of significant curvature and penile retraction leading to loss of function (“penile cripple”) following the removal of an infected Penuma implant. The Penuma implant (rebranded as the Himplant) is a tailorable soft silicone sleeve penile implant that has received FDA clearance for its use in the correction of soft tissue deformities.25,26 However, there are no absolute indications for Penuma. A single center reviewed 355 cases of cosmetic elongation, enlargement, and combined elongation/enlargement phalloplasty with autologous fat obtained from liposuction. 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