Background: The replacement of a congenitally absent or surgically removed testicle is done historically by a saline implant. Borrowing from saline breast implants, a small fluid-filled shell is used as the testicular replacement. This has been the standard device used as a testicle implant since the early 2000s. It is currently the only FDA approved device for such indications.
While it is a marvel of engineering to make such a diminutive device that can be filled with a few ccs of fluid, it is a conceptually flawed device. The natural testicle is not hard like a fluid filled device nor does it ever have the risk of spontaneous deflation. Its size options are also limited and trying to increase their size by greater fluid fill only makes the implant get even harder.
One unique phenomenon that can happen to testicular implants is that of capsular contracture. While well known in breast implants it can occur in any spherical device that is placed in the body. The surrounding scar layer can thicken and contract, making the implanted device feel firm and potentially distorted. As the only other spherical device placed in the body other than breast implants, this same postoperative problem can develop in testicle implants as well.
Case Study: This younger male had a saline testicle implant placed as reconstruction from a lost testicle from a varicocele. He had it in place for three years but never liked it because it felt too hard, did not move and was smaller than the other side. It also was positioned too high and caused noticeable scrotal asymmetry.
Under general anesthesia and through a high scrotal incision, his existing saline implant was removed. A capsulotomy was performed to extend the pocket back down into the lower end of the scrotum to match the other side. A larger 5.5cm oval ultrasoft silicone testicle implant was placed in to the new pocket. His immediate intraop result showed a much improved scrotal asymmetry.
The ultimate success of a testicle implant is that is matches in size that of the opposite testicle and remains soft and easily moveable. Since it is non-functional its cosmetic characteristics are essential. Ultrasoft silicone implants have numerous advantages over saline, the least of which is that they can never fail or deflate.
- Saline testicle implants often feel hard and are too small.
- A small hard testicle implant can be prone to capsular contracture, increasing scrotal asymmetry.
- Silicone testicle implants offer soft long-term results for a more natural scrotal appearance and feel.
Dr. Barry Eppley