Custom testicular implants are an appropriate and commonly considered solution for men with atrophied testicles, particularly when standard off-the-shelf implants do not provide adequate size or shape. These implants are most often used for aesthetic enhancement using a displacement, side-by-side technique. The success of this approach relies on the implants being large enough to visually and physically obscure the smaller native testicles.
In nearly all cases, standard implants are insufficient for this purpose. The largest commercially available implant measures approximately 5.0 cm, which is typically inadequate to achieve meaningful displacement. As a general guideline, an implant must be at least 70% larger in overall dimensions than the natural testicle to be effective. For this reason, custom implant designs are usually required.
Implant Material and Design
Custom testicular implants are fabricated from solid medical-grade silicone elastomer, which offers several advantages:
- Long-term proven safety and material stability
- Durable construction with a predictable, natural feel
- No need for replacement, as the material does not degrade
- Ability to be custom-molded to precise dimensions
- A hollow internal chamber to enhance softness
- Option to pack the hollow chamber with antibiotics for postoperative release
Customization Options
Custom implants can be tailored to meet individual patient needs, including:
- Exact dimensions (length, width, and volume)
- Shape (ovoid versus more anatomically contoured designs)
- Firmness (via durometer adjustment)
- Weight, which is important for a natural scrotal feel
- Asymmetric sizing when required
Manufacturing Process
Custom testicular implants are produced by specialty medical silicone manufacturers and are FDA-compliant under the custom device (patient-specific) pathway. Implant designs are created using CAD-CAM technology based on the desired length-to-width ratio and overall dimensions. Typical manufacturing lead time ranges from four to six weeks.
Case Study
A 69-year-old male presented with long-standing concerns regarding small testicular size. Although both testicles were present, they were significantly atrophied and retracted superiorly within the scrotum. The scrotal sac itself was small and tight, with the testicles estimated to measure approximately 3.0 cm or less.
Under general anesthesia, a small midline scrotal incision was made. Bilateral subdartos pockets were carefully developed, maintaining a thin septum of tissue between them. Custom 6.25 cm implants were prepared, and their hollow chambers were filled with vancomycin antibiotic powder.
Each implant was placed into its respective sub dartos pocket, and a meticulous four-layer closure was performed using resorbable sutures. With a 100% increase in size, the enhancement of the scrotum was immediately apparent.
Discussion
The risks and potential complications of custom testicular implants are similar to those associated with standard implants and include:
- Infection
- Asymmetry
- Capsular contracture (rare)
- Chronic discomfort
- Excessive or inadequate size
When properly designed and sized, custom implants do not inherently increase complication rates.
Although these implants are used for aesthetic enhancement, they are not known to adversely affect fertility or hormone production. While they may make testicular self-examination more challenging, they do not increase the risk of testicular cancer and do not interfere with diagnostic imaging of the native testicles.
Bottom Line
Custom testicular implants are an excellent option for patients with atrophied testicles when standard implants are inadequate. Careful attention to sizing, material selection, and surgical technique is essential to achieving a natural, symmetric, and durable result.
Barry Eppley, MD, DMD
World-Renowned Plastic Surgeon