Background: Replacement of a undeveloped or removed testis can be done with the placement of a testicular implant. The history of testicular implants goes back well over fifty years and has included a variety of material compositions. The most satisfying device became the silicone gel-filled testicular implant due to its feel. But like silicone breast implants, it went into exile when the FDA pulled silicone breast prostheses off the market in the early 1990s.
To create a viable device for the men who would benefit by a testicular implant, saline filled testicular implants became clinically available in 2002. Today they remain as the only FDA-approved testicular implant. The outer shell or bag of the implant is made of a thin silicone but it is filled with with a saline solution at the time of surgical implantation. It comes in four different sizes with implant volumes ranging from extra small to large.
While the saline testicular implant is stated to have about the same weight, shape and feel of a normal testicle, not all men say that it feels similar to their opposite normal testis. A saline testicular implant in some men can feel more firm as it is less compressible due to the saline water being under tension. This is not unlike how an overfilled saline breast implant may feel to some women
Case Study: This 60 year male had a left saline testicular implant placed one year after his original testis was removed due to infection. He did not like the size and feel of the implant from the very beginning. It felt too hard and was only about half the size of his normal right testis. A new custom testicular implant was made from a very low durometer silicone material and was designed by taking caliper measurements of his right testis. The custom implant measured 57mm long by 42mm wide. By feel it was very ‘squishy’ and easily compressible.
Under general anesthesia. his old high scrotal incision was reopened and the saline implant removed. The scrotal sac was inverted and the existing capsule was scored so the implant pocket would stretch out to contain a testicular implant that was 50% larger. The new custom silicone testicular implant was then inserted and scrotal opening closed in three layers with resorbable sutures for the scrotal skin.
The improvement in the scrotal sac symmetry was immediate with an increased lowering and fullness to the left scrotal side. By size and feel it felt much more like his right testis.
A custom silicone testicular implant can be an improved option for an existing saline testicular implant that is not big enough or feels too firm.
Highlights:
1) Saline testicle implants can potentially feel unnaturally hard and may be undersized for some men
2) A smooth and soft solid silicone testicle implant can feel more natural than a saline testicle implant.
3) For a larger sized testicle, a custom made silicone testicle implant can be made and used for either primary placement or for replacement of an inadequate saline testicle implant.
Dr. Barry Eppley
Indianapolis, Indiana