Placement of a 3-piece inflatable penile prosthesis (IPP) serves as definitive treatment for erectile dysfunction, and we sought to examine an alternative reservoir placement technique using the midline approach in patients with previous pelvic surgery. We highlight and describe the authors’ initial experience of midline reservoir placement for inflatable penile prosthesis. We collected data from patients with a history of bilateral inguinal surgery, unilateral herniorrhaphy, or a pre-operative physical exam revealing bilaterally patulous inguinal rings. The midline approach was performed on all patients undergoing IPP meeting the inclusion criteria from Feb 2018 to May 2020. Both virgin and revision IPP cases included. Intraop and postop morbidities were recorded. A segmented numeric version of the visual analog scale (VAS) was utilized to reflect pain intensity directly related to the midline approach to reservoir placement. Patients were evaluated for lower urinary tract symptoms in the preoperative and postoperative setting using the International Prostate Symptom Score (IPSS). A total of 125 (2 AMS 700 and 123 Coloplast Titan) patients underwent infrapubic IPP procedures utilizing midline reservoir placement. Of the 125 midline reservoir placements, 39 were revision cases, 3 of which underwent only reservoir exchange. The VAS (VAS range 0-10) was used to assess pain within one and at four weeks of follow-up. Midline reservoir placement was associated with minimal pain at the reservoir site, with all patients reporting a score of 1 at the four week follow up. Overall pain was also assessed with the VAS. At 1 week, mean VAS score was 1.86 (median 1, range 0-7). At four weeks, the mean overall VAS score was 0.56 (median 0, range 0-6). We describe a midline IPP reservoir placement that allows the surgeon to safely and effectively access the area posterior to the abdominal wall thereby precluding device palpability, while decreasing operative time, and minimizing patient reported pain at the reservoir site.