The size of a male’s scrotum is rarely an aesthetic issue and is often paid given little attention. But as men age and particularly if they undergo a lot of weight loss their scrotum may get larger by virtue of the development of loose skin. Such scrotal enlargement can be more than a cosmetic concern but can cause skin irritation and discomfort in tight or athletic clothing.
A scrotal deformity can affect the size and symmetry of the sac alone or where it joins with the penis, most commonly seen as peno-scrotal webbing. Issues such as the amount of scrotal sac hanging or sag and asymmetry between the two scrotal halves are frequent aesthetic concerns. There is also the issue of the appearance of the scrotum during erection and sexual activity.
Scrotoplasty is a surgical procedure that reduces the scrotal skin sleeve but strives to maintain its normal shape at the same time. While the need for scrotal reduction/scrotal lift is not common, this does not make it any less significant to those men so affected. The best approach for scrotal skin reduction for sagging correction is a midline approach keeping the excision and the final skin closure along the vertical raphe between the scrotal halves. This is a natural and logical place for a scrotal skin scar.
The amount of midline scrotal skin removal is a matter of judgment and preoperative marking. But when closing the vertical excision site it is helpful to plicate the muscle layer (dartos fascia/muscle) to help reduce the tension on the overlying skin closure. This will also prevent postoperative skin stretching from the weight of the testicles.
Another common scrotal deformity is that of peno-scrotal webbing. Usually the junction of the base of the penis and the scrotum is not clearly demarcated. When a web of skin is present across this interface it can make the penis look short on its underside. This webbing can be due to a lack of adequate skin caused by congenital development, a prior aggressive circumcision as an infant or the creation of a pseudo web due to weight loss. Small webs can be lengthened by a direct z-plasty while large webs require a vertical excision of loose skin with a z-plasty placed directly over the peno-scrotal junction. In men who have undergone a lot of weight loss this can be combined with a pubic lift for an overall reshaping effect.
Scrotoplasty is a plastic surgery option for men who are bothered by scrotal sac deformities. A tightened and uplifted scrotum and/or a more defined peno-crotal junction can be surgically created.
Dr. Barry Eppley
Indianapolis, Indiana