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Enlargement of the size of the testicles for aesthetic purposes can only be achieved with implants. Such testicle implants can be placed in either a side by side technique or as a wrap around implant. Each has their advantages and disadvantages as well as indications.The primary indication for the wraparound implant is when one’s natural testicle implant size is significant enough that a side by side technique can create the appearance of four testicles in the scrotum.

But regardless of the testicle implant technique what they all share is that it takes time for the final and natural looking result to be achieved. With the placement of any implant into the scrotum there is an initial tightness and elevation of the implant due to the limited immediate expansion of the scrotal skin. With the average large testicle implant volume of 90ccs (with 6.5cm implants) the added volume of nearly 200ccs causes an immediate stretch of the skin.

As a result the patient should expect that the initial result will look quite unnatural. It will be high and tight. But the advantage of any skin coverage in the body is that it will stretch due to the natural relaxation of the elastin fibers in the dermis and overall skin creep. While this postoperative process is assured it is one that takes time. Between the resolution of swelling (six weeks) and the completion of the skin relaxation phase, it can take up to three months after surgery until the final result is seen. 

The final surgical result, of course, means when the testicles are soft and hang naturally. Like the natural testicles they will be one higher than the other one in most cases. This almost always relates to which implant was placed first during surgery. The one that was placed first always achieves the lowest position in the scrotum.

One preoperative and one postoperative treatment may accelerate the testicles achieving an earlier relaxed position. Preoperative Botox injections (Scrotox) can help the subcutaneous muscle layer to relax before the implants are placed resulting in less immediate tightness. (this will not accelerate the skin relaxation process however) Postoperative stretching of the scrotum (when it feels comfortable to do so) can certainly help through a variety of devices which are commercially available.     

Dr. Barry Eppley

Indianapolis, Indiana

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