Background: The current state of testicle implants is closely tied to that of breast implants. When the silicone breast implant moratorium was instituted in 1991 that also applied to every other aesthetic body implant that was composed of silicone gel. Away went silicone testicle implants and the search for an FDA-approved replacement took over a decade before a saline-filled testicle implant was introduced and become widely commercially available again.
A saline-filled testicle implant is not the best testicle implant for a variety of reasons. Because it is saline-filled it can and many will eventually fail (deflate) and need to be replaced. As a filled saline implant is under pressure from the indwelling fluid it will feel more firm than a natural testicle. Lastly, the maximum size of saline implants is often smaller than many men would prefer.
A saline testicle implant is a perfectly safe medical device and it can be effective for some male patients. And it continues to be widely used because that is what most Urologists know and are familiar. But a silicone testicle implant offers a permanent implant that can not fail, is much softer and can be made in much larger sizes. The key with its use is that larger sizes over 5.0cms must be custom made.
Case Study: This male had a prior testicle implant history with saline implants complicated by wound breakdowns and resultant hard and small implants with one appreciably higher than the other. He desired larger implants that were softer and were positioned lower.
Through a 3cm midline raphe scrotal incision the saline implant capsules were found, entered and intact small implants removed. Capsulotomies were performed and new solid soft 6.5cm silicone implants placed. A comparison between the new silicone and removed saline implants showed the size difference. The immediate intraoperative results at closure also showed the external size difference in the scrotum.
Besides size the biggest patient complaint about saline testicle implants is their feel. They universally feel too firm as the natural testicle is not a completely fluid filled tissue sac. Its composition is more spongy tissue which is better replicated by a more solid gelatinous material.
1) Traditional saline testicle implants for some patients do not have enough size and feel to firm to achieve a satisfactory aesthetic result..
2) Custom testicle implants are good replacements for saline implants because they can be much bigger and feel more natural. (softer)
3) Regardless of how the original saline implants were placed the best incisional approach for replacement is through the midline raphe which ensures the implant pockets will be as low as possible.
Dr. Barry Eppley