Testicle Implant Surgeon Dr. Barry L. Eppley

TESTICLE IMPLANTS FOR MEN

The historic use of testicle implants is for reconstructive purposes to replace a lost testicle due to trauma, torsion, removal due to cancer or do to congenital absence. While this use for testicle implants still remains so currently, it bas become expanded for more aesthetic applications today as well. For the male that has had shrinking of their natural testicle size due to age or testosterone therapy or for the male with an average testicle size that desires an aesthetic enlargement, testicle implants are available to do so with innovative styles, sizes and material modifications.

The first contemporary innovation in testicle implants relates to its material composition. Saline-filled testicle implants are most commonly used for reconstructive purposes in replacing the lost testicle. While effective they have multiple undesirable properties including a very hard feel (water under pressure in a bag), the potential need for replacement due to failure (deflation due to disruption of the bag/shell of the implant) and limited size options. These features make them unappealing to the aesthetic testicular enlargement patient. Ultrasoft solid silicone implants are now available which have a much more natural feel. Due to their softer feel they could be called gummy bear testicle implants. Besides the more natural feel these implants will never need to be replaced due to device failure.

Standard solid ultrasoft testicle implants are available up to 5.0cms in size. (this is their length with a width ratio of 0.7 that of the length) Beyond that size custom implants can be designed and such custom or XL testicle implants have been implanted up to 7.5cms in size. The custom testice implant approach far exceeds what is available in saline beyond having a better feel.

Testicular enhancement or enlargement refers to the male with his existing testicles who wants their size increased. To do so there are two techniques, a wraparound implant and the use of a side by side implant. The wraparound method uses an implant that is either a 1/2 to 3/4  shell or cup which partially encases the existing testicles or is a complete implant with a hollow inner chamber into which the testicle fits. The wrap around concept has its appeal but can incur the complication of separation of the implant from the testicle after surgery. Despite suturing it into place with permanent sutures this potential complication can not be completely avoided.

The side by side testicular enlargement technique uses a solid implant which displaces the natural testicle up and behind the implant, becoming the visible testicular structure seen. This concept works as long as there is a significant size difference between the natural and implant testicle. A 50% to 100% increase in size discrepancy is needed. (e.g., a 6.5cm implant with a 3.5cm natural testicle) The major advantage to this testicular enlargement approach is that with a solid implant there can not be the potential complication seen in the wrap around approach.

Technical improvements include the use of a midline incision low on the scrotum. While some patients may already have higher groin or scrotal incisions from prior testicle surgery, I do not use them. Ensuring that the implant is positioned and stays low is done by coming from an inferior direction. The incisions are smaller than the diameter of the implants and with a multilayer closure there are no concerns about wound breakdown or implant extrusion.

Testicle implants have a history of being sutured into place and I still see it being done today. I see no purpose to this technical step and it often creates a tethering effect or a palpable knot where the suture is. While the natural testicle may be attached by a neurovascular cord, which has specific biologic reasons for being so, this does not apply to an implant. An implant should be allowed to hang and move freely.