Background: For testicular enhancements to be effective by a side by side technique using a custom implant its size must be a certain percent bigger than the natural testicles. As a general rule that percent increase is in the 2/3s to 75% larger. For example if the natural testicles are 3.5cm then an implant size would have to be in the range of 5.8 to the 6.2cms. Since the largest standard testicle implant is 5.0cms this explains why custom implant designs are needed for this form of testicular enhancement.
When it come to picking a custom implant size the question is how is that done. First the known size of one’s testiocles needs to be measured. This can be done wrapping the scrotal skin tightly around one’s testicles and measuring their length. The most definitive method is to get a scrotal ultrasound where exact testicle sizes can be most accurately determined.
Secondly what size custom implant should be made? One could simply use the ratio formula which is always a safe choice. The other approach is to use models such as duck and good eggs and even make model clay sizes. In the end it is an estimate as there is always the unknown variable of how one will feel about the new size which is never completely evident until one has them in place for awhile.
Case Study: This middle-aged male desired testicular enhancement using a side by side technique. His natural testicles measured 3.5cms and he was confident that a 6.5cms size would be adequate.
Under general anesthesia and through a low midline scrotal incision 6.5cm custom testicle implants were placed. As always such space occupying masses cause an immediate high and tight scrotal appearance.
But within a few months the scrotum relaxes and the implants drop and more natural, albeit larger, appearance results. Six months later the patient realized he made a ‘mistake’ and picked a size that was too big. (My initial recommendation was 5.5 or 5.75cm size)
Thus he subsequently underwent an implant exchange down to 5.5cm size. In so doing some capsule was removed and tightened to adjust to the smaller implant size.
When considering what is an oval or ellipsoid implant shape the concept of volume displacement is understandably overlooked. The linear length of the implant is easier to visualize but the true effects of an implant with this shape is its volume. The volume of a testicle implant can change dramatically with just a 0.5cm length change and particularly with a 1.0 longitudinal axis increase.
Key Points:
1) Custom implants using the side by side technique are effective at testicular enhancement and the scrotal incision heals in a near inconspicuous appearance.
2) Implant size selection is an estimate based on various siding methods and, rarely, a patient may over estimate the implant size and desire a secondary implant size reduction.
3) Downsizing testicle implant size can be done and, if significant enough, may require some capsular excision/plication as well to make the inner pocket smaller.
Dr. Barry Eppley
World-Renowned Plastic Surgeon