Background: The only viable replacement for a lost testicle is that of an implant. Placing an implant in the scrotal sac has a very low risk of any significant complications such as infection or a hematoma. This because the anatomy of the scrotum is fairly straightforward and the testicular replacement must merely provide a static volumetric substitution for the space previously occupied or would have been occupied by the normal testicle.
The aesthetic demands of a testicular implant is what represents the most common postoperative problems with them. Size discrepancies (usually too small), an implant that feels too firm and lack of implant mobility are the most common complaints with testicular implants. These have all been associated primarily with saline-filled implants whose hydrodyamic properties are not necessarily an ideal substitute for a more naturally solid soft tissue structure.
What is unique about the aesthetics of the testicle is that how it feels and moves about between the upper inner thighs is equally, if not more important, than that of its appearance. (scrotal symmetry) The scrotal sac ends up being partially compressed between clothing and the skin which creates awareness of how it feels. While the scrotum is a suspensory soft tissue envelope, this is not how it is primarily perceived. (we spent a lot more time in clothes than out of them)
Case Report: This 35 year-old male had a history of a left saline testicle implant being placed for a congenital undescended testicle. The implant felt too firm and had a visibly smaller size compared to the opposite normal right side.
Under general anesthesia and using the existing high scrotal scar, the implant pocket was opened and the indwelling implant removed. A capsulotomy was performed to expand and lower the implant pocket. A solid soft testicle implant measuring 5.0 x 4.0cms was chosen as the replacement which appeared about 30% bigger in overall volume. Better scrotal symmetry was achieved with its placement and closure.
Sizing testicle implants can be challenging but almost always the size needs to be bigger than what one would think. Many patients often end up between two sizes and it is important to ask the patient before surgery if they would prefer to be a ‘little too small’ or a ‘little too big’.
The feel of a testicle implant is often very relevant and may supersede that of a size discrepancy. It is hard to get around the material feature that a saline implant just doesn’t feel normal, it almost always feels too firm particularly if it has been filled to its minimal volume or has any amount of overfill at all. Low durometer solid silicone implants always feel more natural as they replicate the compressibility of a normal testicle better
Case Highlights:
- Replacement of saline testicle implant with a solid silicone one results in a soft more natural feel.
- To accommodate a larger implant in the scrotal sac, a release of the scar tissue (capsulotomy) is usually needed.
- Sizing of the new implant is best done by measurements taken from the existing implant during surgery and choosing a new implant with larger dimensions
Dr. Barry Eppley
Indianapolis, Indiana