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Since the 1990s diverse kinds of graft materials have been used for penile augmentation surgery. There may be a difference in effects and complications according to the grafts as well as in the surgical technique. Recently, Type I collagen implant has been used and the safety has been improved and surgical techniques have been developed. This paper aims to report clinical safety, histologic findings and surgical techniques in complex phalloplasty using type I collagen.METHODS: Type I collagen derived from bovine pericardium (Lyoplant®) was used for surgery. It has micro porous fibrous structure for rapid and regular ingrowth of autologous connective tissue. We have performed complex phalloplasty with minimal incision that enables simultaneous surgeries for glans augmentation, lengthening and girth enhancement. In the dorsal area, 1-2 em from the subglans was incised at a length of 3 to 5 em and was dissected up to the prepubic junction. Then, a section of a fundiform ligament was incised for lengthening. Glans and Buck's fascia were dissected at the subglans. Implant was designed according to the size of the penis, with about 3-5 em in width, 4-6 em in length, and 3-6mm in thickness. By dissecting the matrix with a knife horizontally and vertically to form a multi-layered slit or dividing the matrix into multiple pieces, the graft success could be increased. Enhancement tissue was inserted between the subglans margin and the Buck's fascia for glans augmentation. Thereafter, Enhancement tissue was placed between the dartos fascia and Buck's fascia RESULTS: The surgery was conducted on 550 patients May 2003 to May 2006. The average augmented effect in circumference was 32% and showed a mean length increase of 2.1 em. As for complications, in case of graft failure, the graft was removed partially or entirely. Some necrosis cases occurred but most of them were treated through conservative treatment. When using the multi-slit and multi-piece technique with minimal incision, complications reduced more remarkably than when the technique was not used. After implantation graft tissue is continuously replaced by endogenous connective tissue in histologic findings.CONCLUSIONS: This complex phalloplasty using type I collagen implant with minimal incision showed positive results in terms of safety and effectiveness. Using the above-described technique will improve safety and recovery as well as the satisfaction. In that sense, it is regarded to be a safe method for penile augmentation surgery in the future.