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Testicular implant enhancement differs from testicular implant replacement in that one’s natural testicles are present. Making them bigger for aesthetic purposes involves one of two techniques based on the residual size of the testicles. If the testicles are small (3.5cms or less) then a side by side method can be used which is effective as the testicle implants overwhelm the much smaller size of the natural testicles. This works when the ratio between the testicle implant size and the natural testicle is at least 1.75 or greater. (e.g., 6.5cm implant/3.5cm natural testicle = 1.86)

But when the natural testicles are more normal size the side by side displacement technique runs the risk of creating a ‘4-testicle’ look. This then requires the wrap around technique in which the implant completely engulfs the testicles and creates an additive external layer to create its enhancement effect.

All wrap around testicle implants are made custom based on both the external desired size and the internal hollow chamber into which the natural testicles will reside. In designing the implant the unknown variable is what the size of the hollow chamber should be which will also affect the thickness of the implant walls. That can only be estimated by a preoperative measurement which is usually provided by the patient.

In placing wrap around testicle implants it is first necessary to dissect the existing testicle with their attached cord out of the scrotum. Then the internal pocket for the larger implant can be made.

The fit of the testicle can be checked by spreading the opening and see how it fits when it is dropped inside it. The ‘fit’ is determined by the size of the hollow chamber, the natural size of the testicle and the size of the opening for the cord. On the one hand the testicle should have a snug fit so the it does not slip out easily. Conversely it can not be too snug, particularly the implant opening, so that vascular compression does not result.

There are benefits for suture fixation of the testicle into the implant, most notably a through and through suture through the bottom of the implant up through the testicle and then back out the implant. Several sutures are also used to tack the cord to the implant at its opening.     

Dr. Barry Eppley

Indianapolis, Indiana 

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