Background: Testicular reconstruction can be effectively done to replace a lost testicle and improve scrotal symmetry. Such scrotal implants can be either saline (fluid-filled) or made of a very soft solid silicone material. I prefer to implant the solid silicone devices as they feel more natural and will never need to be replaced due to device failure.
The most logical use for testicular implants is to replace a lost testicle. Whether that loss has occurred from cancer, trauma, a medical condition or a congenital absence, the necessary space inside the scrotum can be created to place an implant. The scrotum is a suspended dual-chambered sac of skin and muscle so a separate space on the absent side can be created that keeps it anatomically separate from the opposite normal testicle via the scrotal septum.
Significant scrotal asymmetry can be caused even though one has two testicles. If one testicle is much smaller than the other one the sac will be very discrepant in size and shape. Adding an implant to the smaller testicle side can be done without removing the existing testicle. While the function of the smaller testicle is not known, it is prudent to keep it for whatever function it may serve.
Case Study: This 30 year-old male had a history of a right undescended testicle. Surgery was done as a child to bring it down into the scrotum which was successful. However the testicle always remained much smaller than the opposite side and was positioned high up in the scrotum. He desired as an adult better scrotal symmetry.
Under general anesthesia his existing mid-scrotal scar was used as access for a right testicular implant. The right testicle was identified and retracted superiorly. A submuscular pocket was made into the lower scrotal sac into which was placed a #4 size soft silicone testicular implant.
For the aesthetic correction of scrotal asymmetry due to a smaller testicle on one side, an implant can be placed into the same scrotal sac. One does not have to remove the existing testicle given its high scrotal position and its unknown contribution to male sexual health.
Highlights:
- Scrotal asymmetry can occur having both testicles with one being smaller than the other.
- A testicle implant can be added to the scrotum on the smaller side for improved symmetry without removing the smaller testicle.
- A solid soft silicone implant creates s more natural feeling testicle.
Dr. Barry Eppley
Indianapolis, Indiana