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Testicular enhancement refers specifically to the enlargement of a pair of existing testicles. This is very different than testicular replacement where a space in the scrotum has usually been pre-established (from yje most testicle) and the exact size of the implant needed is known given the presence of the opposite remaining testicle. 

Working with existing testicles and making them appear larger can only be done two ways. Either wrap an implant around the testicle whose thickness becomes its new size or place an implant beside it whose size overwhelms the natural testicle and makes it ‘invisible’. Known as the side by side or displacement technique its main advantage is that disengagement of the implant from the testicle can not occur. (as can with the wrap around technique)

While usually the choice for most testicular enhancement patients there are certain concepts that make it effective as well as some expected recovery issues. Displacement or camouflage of the existing testicle requires an implant that is at least 75% larger in size. This means, for example, that a testicle size of 3.0cms must have an implant that is least 5.25 or 5.5cms in size. (most patients opt for 6.0cms or larger) More size of course is better but this is the minimum. This is why standard implants never create enough displacement given that their maximum size is 5.0cms. Inadequate implant size will create the visibility of both testicles and implants or a 4 ball appearance. Only a custom implant design can assure adequate size to be effective.

The natural testicle is attached by a neurovascular cord which places it on a tether.  An implant has no such attachment which gives it the advantage of being able to be placed low in the scrotum where it can push the natural testicle upward. To ensure a low implant position the incision should be placed in a low midline location near the bottom of the scrotum where all of the dissection is in a superior direction.

In placing custom testicle implants it can initially seem like they will not fit. They seem too big to pass through the incision and the stretch of the scrotum seems inadequate for both implants. But with persistence and good pocket dissection the implants are able to fit. In doing this dissection every effort is amend to maintain a midline septum of tissue between the two implant pockets.

But because of the size of the implants and immediate stretch of the scrotum the implants will be initially high and tight. They will have no natural hang to them. It takes a while for the tissues to relax until a more natural and expected appearance occurs. (months) There is usually a more dominant implant side or different appearing implants initially due to the tight fit. One implant will be more visible or have a more anterior and/or posterior position  to it. This will change as healing and tissue relaxation occurs.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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