This is only my speculation with
PMMA, but I think that if you are building the collagen while
Flaccid, it will not stretch as easily when
Erect. Keeping it stretched is important.
In other procedures, I'd assume it is scar tissue retraction (happens in a lot of surgery) or trauma.
Most fibrotic problems soften up after a year or so... so length should come back - particularly if stretched regularly.