Background: The most common device for replacement of a lost testicle is that of a saline implant. While this is the only FDA-approved implant for this purpose, it is actually not a good concept for a prosthetic device sitting in the scrotal sac. It most certainly does not feel natural (more firm than a natural testicle) and often is undersized for some men. In addition the concept of attaching it inside the scrotum using a fixation suture is prone to causing a tethering effect. Because it is a fluid-filled device a saline implant has a lifelong risk of failure by rupture of the containment shell. This will result in the need for future replacement surgeries.
A soft but solid silicone implant is far superior as a testicle implant. Very low durometer silicone that feels extremely soft (squishy) has far better material properties to reside inside the hanging and mobile scrotum. Because it is a solid implant it can also never deflate.
Exchanging a hard saline implant with a larger silicone testicle implant requires management of the capsule. If the existing implant capsule is not released (capsulotomy) or in some areas removed (capsulectomy), the implant will remain positioned too high. While no two testicles are every at exactly the same level, significant horizontal positional asymmetries are aesthetically undesireable.
Case Study: This 35 year-old male had a history of a left testicular implant placed in his teenage years after a traumatic injury caused loss of the testicle due to torsion. The implant was replaced with a larger saline implant more recently but he was unhappy with the aesthetic result. It was positioned too high and felt tethered into this position. He presented for a silicone testicular implant replacement.
Under general anesthesia his existing high inguinal incision was reopened and the indwelling saline implant removed including the fixation sutures. A new silicone implant was chosen that was 1/3 bigger. With the implant removed the scrotal sac was inverted through the incision and the implant capsule released and partially removed. This allowed the pocket to be developed to the bottom of the scrotum. The new silicone implant was then inserted. The incision was closed in layers with no fixation suture used to the implant..
Silicone is a superior testicular implant material because it is softer, comes in larger sizes and will never need to be replaced due to device failure. When replacing an unsatisfactory hard saline testicular implant, almost always a larger size is needed.
Highlights:
1) Saline testicle implants can feel too firm and may be of inadequate size for some men.
2) Replacing a high tethered saline testicle implant requires a scrotal sac capsulorraphy.
3) Silicone testicle implants offer a much softer feel and bigger sizes than saline implants.
Dr. Barry Eppley
Indianapolis, Indiana