Background: Testicular enhancement is most commonly done by a side to side implant displacement method. With this approach a custom testicle implant is used that is bigger than the natural testicles. This is effective by becoming the most dominant structure seen in the scrotum through displacement of the natural testicles upward towards the inguinal canal. This occurs because the natural testicles are attached by a cord which retracts upward. As the implant has no such attachment it can end up lower and will hide the natural testicles if it is big enough.
While the custom testicle implant displacement has a low risk of complications in general it is not perfect and occasionally patients may develop some show of one of their natural testicles.This is not common and does not usually present itself unless one of the custom implants drops significantly lower than the other usually due to exixting/indwelling scars from prior surgeries.
Eliminating a natural testicle show after custom implant placements can consist of either repositioning the custom implant higher, relocating the testicle or removing it or placing larger custom implants. As a general rule repositioning the custom implant would be the least effective and removing the visible testicle the most effective. Eliminating those two options leaves a placing a larger implant with or without natural testicle repositioning.
Case Study: This male had two prior testicle implant surgeries while keeping his natural testicles. My involvement was one surgery ago to remove small testicle implants and replace them with 6.5cm custom implant which did adequately increase the size of his scrotum and provided complete camouflage of his right natural testicle. But the left custom implant settled lower and the natural testicle above it became exposed.
Under general anesthesia and through his existing midline scrotal scar his existing 6.5 implants were removed to be replaced by new 7.25 implants with a hollow inner chamber.
The left natural testicle was dissected out and a pocket for it created more posteriorly. With the placement of bilateral 7.25 implants placed with the aid of a funnel device the implants became more symmetric and the left natural testicle hidden. It remains to be seen with time hewn effective this approach is for resolving the left natural testicle show.
Key Points:
1) Significant custom testicle implant asymmetry is uncommon and may result in natural testicle show.
2) Previous surgery, scar and implant capsules can result in a lower than desired implant position once healing and relaxation has occurred months later.
3) Correction of natural testicle show can include larger testicle implants, capsulotomies and natural testicle repositioning.
Dr. Barry Eppley
World-Renowned Plastic Surgeon