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Background: Testicle implants are an accepted and low risk device that can effectively create the appearance of a testicle in the scrotal sac. Available in saline-filled and solid silicone styles, their effectiveness is judged by having an adequate size and feeling soft and slightly compressible. Because of larger sizes and a softer feel to the implant, the solid silicone device would be judged to be superior in the scrotal location.

IIn testicular restoration one the most important criteria is size of the implant. While solid silicone implants are available in five different sizes, up to 5cms in linear length or 5.5vm in arched length, there are men where even larger implants are needed. Such implants can be made on a custom basis to dimensions that are only limited by the stretch of the scrotal skin.

The need for extra large testicle implants is most commonly needed in aesthetic penile-scrotal disproportion. This can be created by penile enhancement procedures where the length and girth of the penis becomes bigger and disproportionate to the natural underlying scrotum. While there are no established measurements or numbers to determine the aesthetic proportionate relationship between penile and scrotal size, patient perception of it becomes the determining factor. 

Case Study: This middle-age male had a history of  having both penile enhancement (fat injections and a pump) and saline testicle implants. He was bothered by the relatively small size of his testicle compared to that of his penis. To meet his aesthetic implant replacement size, custom testicle implants were made with a linear dimension of 6 cms ands and arced length of 6.5 cms.

Under general anesthesia a median raphe incision was used to access both sides of the scrotum. A thick layer of  tissue was maintained in the middle. The saline implant pockets were opened and the devices were removed including their fixation sutures. The capsule was released in many linear lines and the scrotal pockets stretched and expanded.  The old saline implants were compared to the new implants. The new custom silicone testicle implants were then inserted and a three layer closure done. A semi-circumferential ring of skin was removed from the base of the penis to get rid of a ‘turkey neck’. (loose skin)

The need for custom silicone testicle implants is indicated when standard sizes are inadequate. Penile enhancements can create penile scrotal disproportions where such larger implants may be needed.


  1. Large testicle implants are only available in silicone and must be custom made.
  2. The scrotal tissue pocket can be released by capsulotomies and skin stretching to accommodate much larger implants.
  3. Custom testicle implants may be needed when their is significant aesthetic penile-scrotal disproportion.

Dr. Barry Eppley

Indianapolis, Indiana

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