Standard ampallangs (versus shaft ampallangs) are done in one of two placements, either transurethral, or not. A transurethral ampallang passes through the urethra. The advantage to this is that the urine helps keep the piercing clean, and because the piercing is effectively divided in half, it's almost like healing two shorter piercings. Also, piercing through the urethra makes this piercing less likely to migrate due to sexual use of the piercing. Some piercers believe that the non-urethral placement feels better for the client, but it also takes longer to heal and is more prone to rejection. Should the wearer also have a PA, this will likely result in pinching.
The ampallang can be performed using either a standard clamp-and-pierce method, a freehand method or a scalpelling method. For any method, proper jewelry size should be determined pre-procedure by measuring the penis while erect. The piercer should keep in mind the angle and placement of the jewelry when taking these measurements. Many piercers will also take this measurement and add a small amount to ensure that the jewelry is not too short. For this piercing in particular it is much easier to deal with jewelry that has too much room over jewelry that is too short. Also, it should be noted that piercings through the male glans are possibly the most painful piercings for a male to receive. This is not a piercing to enter into lightly and the discomfort level should not be mistaken for that of a Prince Albert Piercing or Frenum Piercing.
After acquiring appropriately sized jewelry, the area should be cleaned and prepped. This typically involves the use of a surgical scrub or similar. It is also common during this piercing to clean the front side of the scrotum in addition to the glans in order to eliminate problems with subsequent contact between the penis and scrotum. A single-use marking instrument should then be used to mark the placement of the piercing. At this point, the head of the penis is lightly clamped and the needle goes through the head. After piercing the tissue, the clamps are removed and the jewelry is transferred into the piercing. It is common for this piercing to bleed (sometimes heavily) for several minutes after the piercing. Many piercers will ensure that the bleeding is controlled and proceed to bandage the piercing to prevent staining of pants. Because the glans of the penis is a high blood flow area this piercing may also bleed in small amounts for several days after the procedure.
The only change between the Freehand Piercing method and the clamp-and-pierce method is during the piercing of the head. Instead of clamping the tissue it is held firmly and carefully in one hand and pierced with the other.
Scalpelling methods are often employed when starting an ampallang at 4 gauge or larger. Scalpelled piercings, especially of this nature, should be left to a well qualified practitioner.
Healing and aftercare
Ampallangs and apadravyas are generally considered the "toughest" male genital piercings. They are some of the most painful to get done, and can take, depending on the subject, between 2 and 6 months or longer, to heal. A last warning: Withdrawing before going flaccid is a very good idea, and a very necessary one in some applications.
Long term health issues
A very important detail: this piercing, contrary to a tremendous amount of hype, is not a good choice for making most female partners happier. Good technique aside for a minute, the nature of the placement rules out direct pleasurable stimulation, and in fact has been known to be irritating for a good deal of people, never mind the possible hardships imposed on the back teeth and the soft palate. As with most piercings, these need to be left in, so seriously consider all possible outcomes before going through with it.
History and culture
Historically, this piercing was performed in various Polynesian cultures, specifically the Dayak people of Borneo, who wore this and/or the apadravya to emulate the rhino, which has a similarly equipped penis courtesy of nature.
Urban legend holds that an ampallang passing through the corpus cavernosum can leave the wearer bleeding to death, but this is not true unless the piercing is done as a dermal punching, in which case all bets are off and you are in for serious bleeding for weeks (although death is still an exaggeration).
More pictures and experiences on ampallangs can be found on BME in the Ampallangs gallery.