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Archive for the ‘testicular implants’ Category

Case Study – Testicular Implant for Correction of Smaller Testicle and Scrotal Asymmetry

Monday, July 3rd, 2017

 

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:

  1. Scrotal asymmetry can occur having both testicles with one being smaller than the other.
  2. A testicle implant can be added to the scrotum on the smaller side for improved symmetry without removing the smaller testicle.
  3. A solid soft silicone implant creates s more natural feeling testicle.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Silicone Testicle Implant Replacement

Monday, June 19th, 2017

 

Background: The only viable replacement for a lost testicle is that of an implant. Placing an implant in the scrotal sac has a very low risk of any significant complications such as infection or a hematoma. This because the anatomy of the scrotum is fairly straightforward and the testicular replacement must merely provide a static volumetric substitution for the space previously occupied or would have been occupied by the normal testicle.

The aesthetic demands of a testicular implant is what represents the most common postoperative problems with them. Size discrepancies (usually too small), an implant that feels too firm and lack of implant mobility are the most common complaints with testicular implants. These have all been associated primarily with saline-filled implants whose hydrodyamic properties are not necessarily an ideal substitute for a more naturally solid soft tissue structure.

What is unique about the aesthetics of the testicle is that how it feels and moves about between the upper inner thighs is equally, if not more important, than that of its appearance. (scrotal symmetry) The scrotal sac ends up being partially compressed between clothing and the skin which creates awareness of how it feels. While the scrotum is a suspensory soft tissue envelope, this is not how it is primarily perceived. (we spent a lot more time in clothes than out of them)

Case Report: This 35 year-old male had a history of a left saline testicle implant being placed for a congenital undescended testicle. The implant felt too firm and had a visibly smaller size compared to the opposite normal right side.

Under general anesthesia and using the existing high scrotal scar, the implant pocket was opened  and the indwelling implant removed. A capsulotomy was performed to expand and lower the implant pocket. A solid soft testicle implant measuring 5.0 x 4.0cms was chosen as the replacement which appeared about 30% bigger in overall volume. Better scrotal symmetry was achieved with its placement and closure.

Sizing testicle implants can be challenging but almost always the size needs to be bigger than what one would think. Many patients often end up between two sizes and it is important to ask the patient before surgery if they would prefer to be a ‘little too small’ or a ‘little too big’.

The feel of a testicle implant is often very relevant and may supersede that of a size discrepancy. It is hard to get around the material feature that a saline implant just doesn’t feel normal, it almost always feels too firm particularly if it has been filled to its minimal volume or has any amount of overfill at all. Low durometer solid silicone implants always feel more natural as they replicate the compressibility of a normal testicle better

Case Highlights:

  1. Replacement of saline testicle implant with a solid silicone one results in a soft more natural feel.
  2. To accommodate a larger implant in the scrotal sac, a release of the scar tissue (capsulotomy) is usually needed.
  3. Sizing of the new implant is best done by measurements taken from the existing implant during surgery and choosing a new implant with larger dimensions

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Long Term Silicone Testicular Implant Results

Saturday, April 1st, 2017

 

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.

One year results showed a soft implant feel and good scrotal symmetry. No recurrence of the capsular contracture occurred. He was very pleased with his results and had developed new self-confidence.

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.

Highlights:

  1. Saline testicle implants often feel hard and are too small.
  2. A small hard testicle implant can be prone to capsular contracture, increasing scrotal asymmetry.
  3. Silicone testicle implants offer soft long-term results for a more natural scrotal appearance and feel.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Silicone Testicular Implant Replacement

Saturday, July 23rd, 2016

 

Background: The most common device for replacement of a lost testicle is that of a saline implant. While this is the only FDA-approved implant for this purpose, it is actually not a good concept for a prosthetic device sitting in the scrotal sac. It most certainly does not feel natural (more firm than a natural testicle) and often is undersized for some men. In addition the concept of attaching it inside the scrotum using a fixation suture is prone to causing a tethering effect. Because it is a fluid-filled device a saline implant has a lifelong risk of failure by rupture of the containment shell. This will result in the need for future replacement surgeries.

A soft but solid silicone implant is far superior as a testicle implant. Very low durometer silicone that feels extremely soft (squishy) has far better material properties to reside inside the hanging and mobile scrotum. Because it is a solid implant it can also never deflate.

Exchanging a hard saline implant with a larger silicone testicle implant requires management of the capsule. If the existing implant capsule is not released (capsulotomy) or in some areas removed (capsulectomy), the implant will remain positioned too high. While no two testicles are every at exactly the same level, significant horizontal positional asymmetries are aesthetically undesireable.

Case Study: This 35 year-old male had a history of a left testicular implant placed in his teenage years after a traumatic injury caused loss of the testicle due to torsion. The implant was replaced with a larger saline implant more recently but he was unhappy with the aesthetic result. It was positioned too high and felt tethered into this position. He presented for a silicone testicular implant replacement.

Testicular Implant Capsulotomy Dr Barry Eppley IndianapolisSilicone vs Salinje Testicular Implant Dr Barry Eppley IndianapolisUnder general anesthesia his existing high inguinal incision was reopened and the indwelling saline implant removed including the fixation sutures. A new silicone implant was chosen that was 1/3 bigger. With the implant removed the scrotal sac was inverted through the incision and the implant capsule released and partially removed. This allowed the pocket to be developed to the bottom of the scrotum. The new silicone implant was then inserted. The incision was closed in layers with no fixation suture used to the implant..

Remove and Replace Testicular Implant result Dr Barry Eppley IndianapolisTesticular Implant Replacement Surgery result Dr Barry Eppley IndianapolisSilicone is a superior testicular implant material because it is softer, comes in larger sizes and will never need to be replaced due to device failure. When replacing an unsatisfactory hard saline testicular implant, almost always a larger size is needed.

Highlights:

1) Saline testicle implants can feel too firm and may be of inadequate size for some men.

2) Replacing a high tethered saline testicle implant requires a scrotal sac capsulorraphy.

3) Silicone testicle implants offer a much softer feel and bigger sizes than saline implants.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Silicone Testicle Implant Surgery

Sunday, May 22nd, 2016

 

Background: While many body parts can be partially replaced or augmented, few can be completely replaced in their totality by a single prosthesis. Such is the case with the testes undoubtably due to its small size and location in the hollows of the scrotal sac. While a testicular implant will not resume the functions of the natural testicle, it can create the external appearance that a pair is present.

The physical and aesthetic requirements of a testicular implant are fairly simple. It should replicate in size and shape that of the opposite testicle. It should also feel soft and supple, not only to match the feel of the opposite testicle, but be easily compressible given its near continuous exposure to external forces.

Testicular Replacement Implant Dr Barry Eppley IndianapolisThe solid but very soft silicone material fulfills all requirements needed for a testicle implant. It is extremely compressible with a very low durometer silicone composition. It is available in sizes up to 5 x 4 cms which will work for most men. A custom testicle implant can be made for even larger sizes.

Case Study: This 55 year-old male lost his right testicle at fourteen years of age due to an unknown pathology. He had a long scar on his right scrotal sac that went its full vertical length. He had always felt inadequate and embarrassed his entire life with a missing testicle and was often referred to as ‘single shot’ throughout his life. He was completely unaware that a testicle implant even existed until very recently.

Right Scrotal ScarTesticular Implant intraoperative sizing Dr Barry Eppley IndianapolisUnder general anesthesia the upper portion of his scrotal scar was reopen and a pocket made into the right scrotal sac. The skin was very elastic and a pocket of adequate size was easily made. The largest size silicone testicle implant was used which matched well to his opposite left normal testicle. The scrotal sac was closed in layers and dissolveable sutures used for the skin.

Right Testicular Implant Reconstruction result Dr Barry Eppley IndianapolisHis immediate intraoperative result showed a good match between the implant and the normal testicle. They had a very similar feel externally.

The use of a silicone testicle implant provides a natural feeling and looking testicle that creates good scrotal sac symmetry. It is a procedure that has minimal discomfort afterward with a rapid recovery. One can return to all normal activities within a few weeks after the procedure.

Highlights:

1) Testicular implants can be done at any age no matter how long ago the natural testicle  was lost.

2) A soft silicone testicular implant provides the most natural feeling replacement prosthesis.

3) Recovery from testicular implant surgery is rapid with a return to all normal activities in a few weeks.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Solid Silicone Testicular Implant Reconstruction

Saturday, May 14th, 2016

 

Background:  Lost of a testicle in a male can occur for a variety of reasons. Congenital absence, an undescended testicle, infection, traumatic injury, varicoeles and other pathologies can all cause an absent scrotal sac on one side. While a man can fully function in all capacities with one testicle, there is psychological benefit for some men to feel and be seen as ‘whole’.

The creation of a normal paired scrotal sac can be done with a testicular implant. There are two types of such body implants currently available. An FDA-approved saline filled testicular implant an a solid silicone contoured caving block in the shape of a testicle. A solid silicone testicle implant is preferred in my hands because it is a permanent implant that will not fail or need to be replaced because of device failure. It can also withstand high levels of impact and compression without risk of rupture or implant deformation.

Case Study: This 35 year-old male lost his right testicle due to several years previously due to benign testicular tumor. He had an otherwise normal scrotal sac skin and had never received radiation for his tumor. Having only one testicle made him very self conscious and was a source of psychological concern.

Right Testicular Implant result Dr Barry Eppley IndianapolisTesticular Implant and Incision Dr Barry Eppley IndianapolisUnder general anesthesia, he had a size 4 testicular implant placed through a high scrotal incision of 3 cms. The soft compressible features of the implant made it possible to insert a 4.6 cm side implant through a much smaller incision than its width. The inserted implant had a fairly good size match to the opposite left testicle and a very similar feel as well.

Testicular Replacement Implant Dr Barry Eppley IndianapolisSolid silicone testicular implants come in a variety of sizes with the maximum dimensions of 5 x 4 cms. Such an implant size may seem large but it is surprising how often it is needed when men are intraoperatively sized.

Men who are missing a testicle should find reassurance that it can be replaced with an implant that feels very natural in sizes that can match the opposite testicle. The implant operation is short with a similarly limited recovery time as well.

Highlights:

1) Reconstruction of a lost or congenitally absent testicle can be safely performed by a silicone testicle implant.

2) The best testicular replacement is a soft solid silicone testicle implant which can never fail or need to be replaced.

3)  A silicone testicle implant can be placed through a small (3cm) skin incision placed high near the scrotal-groin crease junction.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Silicone Testicular Replacement

Sunday, January 24th, 2016

 

Background: Testicles are naturally paired structures residing in the scrotal sac. Loss of a testicle can occur for a variety of reasons which in an adult male is usually due to cancer or a traumatic injury. Scrotal sac asymmetry obviously occurs when only one testicle remains. Whether having only one testicle is a concern will vary for each man so affected.

Softer Silicone Testicle Implant Dr Barry Eppley IndianapolisFor those men bothered by scrotal sac asymmetry, testicular replacement surgery can provide a straightforward and low risk solution. There are two implant options for testicular replacements, saline-filled and solid silicone. There is little question that the ultra soft, low durometer silicone testicular implant offers the most natural feel. In addition, they offer no risk of mechanical failure over a patient’s lifetime. This is unlike saline testicular implants which have an increasing risk of spontaneous deflation the longer they have been implanted.

Testicles obviously are different in size for each man. Presumably a pair of testicles has the same size although size discrepancies in the same man are known to exist. It would also be anticipated that the larger the man, the bigger the testicles are. Thus, a range of silicone testicular sizes are needed to properly service the broadest range of male patients. Size ranges exist from 2.5 x 2cms to 5 x 4 cms. Sizes can be determined by preoperative measurements or the use of intraoperative sizers.

Case Study: This 40 year-old man had his right testicle removed several years previously due to cancer. He was having other surgical procedures and desired to have it replaced at the same time. He had not had radiation after his testicular cancer surgery.

Testicular Implant Sizing Dr Barry Eppley IndianapolisUnder general anesthesia a 4.5 x 3.5cm silicone testicular implant was placed into a created scrotal pocket. This was done through a high scrotal incision placed near the groin crease. The size of the implant was based on measurements and feel of the opposite testicle with a range of implants available at the time of the procedure.

Right Testicular Replacement result Dr Barry Eppley IndianapolisThe proper size of a testicular replacement is just as important as the implant having a similar feel to the opposite normal testicle. Preoperative measurements can be done before surgery to have the proper implant size available for surgery. The alternative strategy is to have a variety of testicular replacement sizes available and made the size judgment during surgery.

Highlights:

  1. Lost of a testicle in an adult male creates scrotal asymmetry and potential self-esteem issues.
  2. Soft silicone implants offer the most natural form of testicular replacement.

3. The sizing of testicle implants can be done by preoperative measurements or intraoperative sizing.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study – Custom Silicone Testicular Implant Replacement

Sunday, December 6th, 2015

 

Background: Replacement of a undeveloped or removed testis can be done with the placement of a testicular implant. The history of testicular implants goes back well over fifty years and has included a variety of material compositions. The most satisfying device became the silicone gel-filled testicular implant due to its feel. But like silicone breast implants, it went into exile when the FDA pulled silicone breast prostheses off the market in the early 1990s.

saline testicular implants dr barry eppley, indianapolisTo create a viable device for the men who would benefit by a testicular implant, saline filled testicular implants became clinically available in 2002. Today they remain as the only FDA-approved testicular implant. The outer shell or bag of the implant is made of a thin silicone but it is filled with with a saline solution at the time of surgical implantation. It comes in four different sizes with implant volumes ranging from extra small to large.

While the saline testicular implant is stated to have about the same weight, shape and feel of a normal testicle, not all men say that it feels similar to their opposite normal testis. A saline testicular implant in some men can feel more firm as it is less compressible due to the saline water being under tension. This is not unlike how an overfilled saline breast implant may feel to some women

Case Study: This 60 year male had a left saline testicular implant placed one year after his original testis was removed due to infection. He did not like the size and feel of the implant from the very beginning. It felt too hard and was only about half the size of his normal right testis. A new custom testicular implant was made from a very low durometer silicone material and was designed by taking caliper measurements of his right testis. The custom implant measured 57mm long by 42mm wide. By feel it was very ‘squishy’ and easily compressible.

Saline vs Silicone Testicle Implant Dr Barry Eppley IndianapolisUnder general anesthesia. his old high scrotal incision was reopened and the saline implant removed. The scrotal sac was inverted and the existing capsule was scored so the implant pocket would stretch out to contain a testicular implant that was 50% larger. The new custom silicone testicular implant was then inserted and scrotal opening closed in three layers with resorbable sutures for the scrotal skin.

Testicular Implant Replacement immediate after result Dr Barry Eppley IndianapolisThe improvement in the scrotal sac symmetry was immediate with an increased lowering and fullness to the left scrotal side. By size and feel it felt much more like his right testis.

A custom silicone testicular implant can be an improved option for an existing saline testicular implant that is not big enough or feels too firm.

Highlights:

1) Saline testicle implants can potentially feel unnaturally hard and may be undersized for some men

2) A smooth and soft solid silicone testicle implant can feel more natural than a saline testicle implant.

3) For a larger sized testicle, a custom made silicone testicle implant can be made and used for either primary placement or for replacement of an inadequate saline testicle implant.

Dr. Barry Eppley

Indianapolis, Indiana

Technical Strategies in Plastic Surgery – Softer Testicle Implants

Saturday, October 25th, 2014

 

The purpose of any body implant is to replicate what is missing or deficient in size or volume. Most of the time this is done for muscle augmentation for most body implants with the exception of the breast. The other lone exception is that of the male testicle.

Testicle implants are designed to replace a lost testicle either through a congenital deformity or one lost through cancer removal or traumatic injury. There are two types of testicle implants based on their composition, saline-filled or solid silicone. Saline testicle implants are the only ones that are FDA-approved but some will eventually fail (deflate) if the containment bag develops a hole and will need replacement.

Solid silicone implants are used on a custom basis for testicular replacement. They have the advantage that they will never fail or need to be replaced because of device breakdown. The implant also costs less to use and does not involve the extra step of adding the filler material to it during surgery.

Silicone Testicle Implants Dr Barry Eppley IndianapolisSofter Silicone Testicle Implant Dr Barry Eppley IndianapolisUnlike saline implants, the feel of silicone implants can also altered by changing its durometer. Durometer is a well known scale of measuring a material’s hardness particularly used in elastomer and rubber materials. This is defined as the material’s resistance to permanent deformation. By changing the degree of polymerization of the silicone, it can have variable degrees of softness.

While there is no definitive test for how hard or soft a testicle should feel, I have found that the soft durometer silicone sphere implant is the most natural feeling. What you don’t want is a testicle implant that feels too hard. Given the tight space between the legs, a soft implant has an advantage.

Dr. Barry Eppley

Indianapolis, Indiana

Case Study: Solid Silicone Testicle Implants

Sunday, September 21st, 2014

 

Background: The scrotal sac normally contains two testicles. Loss of one of the testicles can occur from a variety of medical conditions from an undescended testes, infection and cancer removal to name a few. Generally, having only one testicle does not affect one’s testosterone levels or the ability to have children. But it does affect the appearance of the scrotal sac and one’s self-esteem.

A lost testicle can be replaced by an implant and have been done so for over seventy years. Initially implants were composed metal, glass, plastic and even foam materials. But the first really successful testicle implants were placed in the 1970s and were composed of silicone gel-filled prosthesis not unlike that of breast implants. But with the breast implant fiasco that was initiated in 1991, silicone gel-filled testicular implants became unavailable. This led to the development and eventual FDA approval of a saline-filled testicular implant (with an outer silicone shell) that is widely used today.

Silicone Testicle Implants Dr Barry Eppley IndianapolisLike is now known with breast implants, the use of silicone testicular implants has never been associated with the development of autoimmune or any other disorders. Unlike breast implants, however, todays solid silicone devices that can be used for testicular implants are not gel-filled but are a soft solid elastomer. Thus they can not leak or rupture and will never break down or need to be replaced because of material failure.

Case Study: This 30 year-old male had an undescended testicle removed as a child. He desired an implant so that he would once again have two testicles and better scrotal sac asymmetry.

testicular implant sizing indianapolis dr barry eppleyTesticular Implant Surgery Indianapolis Dr Barry EppleyPrior to surgery, testicular sizing was done using soft solid silicone oblong implants. An implant size of 3 x 3.8 cms was chosen as a good match to the existing testicle. Under sedation anesthesia, a high lateral scrotal incision was made. After passing through Dartos muscle, an implant pocket was made by finger dissection. The implant was soaked in an antibiotic solution and then inserted into the freshly made pocket. The scrotum was stretched out to determine good implant positioning and size. The incision was closed in several layers with dissolveable sutures under the skin. A skin glue was applied for dressing.

Testicular Implant results Dr Barry Eppley IndianapolisHe reported no pain after surgery and only some moderate scrotal swelling. He had good testicular symmetry and a fuller appearance to his scrotum. He reported his recovery as being better than he anticipated.

Testicular restoration by implants can be done successfully using FDA-approved saline-filled or off label solid silicone devices. Solid silicone has the advantage of being more economical and will not ever need to be replaced due to material failure by leakage or los of shell integrity.

Case Highlights:

1) Loss of a testicle creates scrotal asymmetry and may adversely affect a man’s self-image.

2) Testicular implant surgery is a simple and effective procedure that helps restore the scrotal appearance and feels natural.

3) Testicle implants are available in either saline-filled or soft silicone elastomer types.

Dr. Barry Eppley

Indianapolis, Indiana


Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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