Penile Implant Pump Placement: Surgical Approaches and Incision Sites

Inflatable penile prosthesis (IPP) placement requires strategic pump positioning for ergonomic access and concealment. Three primary approaches exist, each with distinct advantages.

1. Infraclavicular (Subclavicular) Approach

• Incision: 2-3 cm in the subclavicular fossa, just below the clavicle
• Pump pocket: Created in the pectoralis major fascia or subpectoral plane
• Tubing route: Subcutaneous tunnel to abdominal wall, then to scrotum
• Advantages: Excellent concealment (hidden by clothing), easy bilateral access, low erosion risk
• Considerations: Longer tubing; may be palpable in thin patients

2. Abdominal (Suprapubic) Approach

• Incision: Transverse or oblique, 3-4 cm above pubic symphysis, below umbilicus
• Pump pocket: Subrectus (beneath rectus abdominis) or prevesical (Retzius) space
• Tubing route: Direct to scrotal components
• Advantages: Shortest tubing, intuitive midline access, good for obese patients (pannus coverage)
• Considerations: Visible if shirtless; seatbelt discomfort possible; higher erosion risk if placed superficially

3. Axillary Approach

• Incision: 2-3 cm in the axillary fossa (armpit), along natural skin crease
• Pump pocket: Subfascial, over serratus anterior or latissimus dorsi
• Tubing route: Subcutaneous across chest wall to abdomen/scroum
• Advantages: Excellent concealment (axillary hair/skin folds), comfortable for seated patients
• Considerations: Technically demanding; axillary nerve/lymphatic proximity; longer tunnel

Decision Factors

Surgical Pearls

• Pump orientation: "Deflate" button inferior for intuitive use
• Pocket size: Snug to prevent rotation/migration
• Tubing: Avoid kinks; leave slight redundancy
• Hemostasis: Critical to prevent hematoma/infection
• Post-op: Pump cycling begins 4-6 weeks (surgeon-dependent)

Revision Considerations

Pump relocation is feasible during revision surgery. Previous pockets may be reused or new sites selected based on patient feedback and anatomy.

Clinical pearl: Patient involvement in site selection improves satisfaction. Demonstrate pump prototypes preoperatively to assess dexterity and comfort.

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Factor	Preferred Approach
Patient habitus (obese)	Abdominal (subrectus)
Patient habitus (thin)	Infraclavicular or axillary
Bilateral hand function	Infraclavicular (easiest access)
Prior abdominal surgery	Avoid abdominal (adhesions)
Wheelchair user	Infraclavicular or axillary
Concealment priority	Infraclavicular or axillary