How Do You Avoid The Four Testicle Look?

Q: Dr. Eppley, I am a young male with hypogonadism. I am currently on the maximum dose of testosterone gel and I am interested in learning more about the side-by-side procedure for testicular enlargement. I have a few questions: How are the implants secured in place to prevent the appearance of four testes? Are my natural testes sutured back while the implants move freely, or is there another method used? How long do the implants typically last? My goal is to achieve a full, masculine-looking scrotum. Thank you for your time and any information you can provide.

A:In answer to your side-by-side testicular implant questions I can provide the following comments:

1) The success of the side-by-side approach, which is determined by avoiding a four testicle look is the size of the implants. With large enough implants the natural testicles are pushed up and back and out of view because they are attached to the neurovascular cord which naturally pulls them up towards the inguinal canal. The size displacement must be at least 70% or more compared to the natural size of your testicles. When surgeons do not appreciate the importance of volume displacement in this type of testicle implant surgery this is how you end up with four testicle look.

I never secure testicle implants by suture fixation. That tethers them down, and Immobilizes them and creates the potential for discomfort.

2) Solid ultrasoft testicle implants are permanent. Because of their material composition they can never degrade or fail and thus never need to be replaced unless you have secondary aesthetic concerns.

Dr. Barry Eppley

World-Renowned Plastic Surgeon