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Introduction: The inflatable penile prosthesis (IPP) has been used to treat erectile dysfunction for 40 years. Loss of penile length following IPP remains the single biggest patient complaint. We describe a preoperative and postoperative patient preparation protocol to assist in setting realistic patient expectations and decreasing the complaint of reduced penile length. Materials & Methods: 750 Patients are instructed to use a vacuum erection device for 10 minutes each day for up to 2 months prior to IPP implant. After two months, maximization of cylinder length is accomplished regardless of IPP manufacturer. Cylinders are left partially inflated in the post-operative period and daily inflation for 3 months immediately upon patient tolerance. The average implanted cylinder length has increased dramatically with the preoperative vacuum usage when compared to the authors’ previous implantations and when compared to the national average of implanted cylinders obtained from one manufacturer. Results: Preoperative use of the vacuum device has allowed maximization of cylinder length. After the vacuum program, patients tend to experience less pain following implantation allowing earlier device instruction cycling and use. The average implanted cylinder length continued to increase annually for the first 5 years as the protocol evolved and seems to have remained stable for the last five years. Conclusions: Preoperative vacuum usage and postoperative capsule management has nearly eliminated patient complaints of reduced penile length. We believe this to be the result of larger size cylinders being implanted when compared to our previous implantations absent of the patient participation protocol.