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Background: Men often seek testicular enlargement due to loss of size from hormone therapy or natural aging. While testicle implants come in a variety of sizes, the first consideration is what type of testicle implant does one want. While they come in two different compositions (saline and silicone) I am specifically referring to the implant style, solid vs wrap around.

While most think of a testicle implant as a replacement for a lost one, they can also be used with an existing testicle present. If the testicle is small enough, usually 3.5cms or less, a much larger testicle implant (6cms or greater) will displace or camouflage the smaller testicle taking a dominant role in appearance. This is the side by side technique and is main advantage is that it is easier to place and has a very low risk of complications. Since it is a solid implant the device can not fail or become displaced. The only aesthetic risk is whether the naturally smaller testicle can ever been seen. In my experience as long as there is a greater than 70% increase in size of the implant over the existing testicle this is not an issue.

The alternative approach to placing an implant with a testicle present is to have it encase or wrap around it. This requires a special implant design that has a hollow center and an opening at one end. The existing testicle will sit inside the chamber and the attached cord will pass through the opening. The important issues with this implant approach is to ensure that the cord is not compressed and how to prevent the testicle from slipping back out of the implant in the long term.  

Case Study: This male desired to have larger testicles with an existing testicle size of 4 and 4.5cms. (not small) The side by side technique would not be a good choice because the risk of creating a four testicle appearing scrotum was signifieant.

Thus he underwent custom 6.75 wrap around testicle implants through a midline raphe incision. Fixation of the testicles into the implant with through and through sutures at multiple locations was used to lower the risk of postoperative prolapse.   

His  3 month results demonstrate the degree of scrotal size increase with bilateral implants. The midline raphe scrotal incision has healed so well at this point that it can not be seen.

The wrap around testicle implant is an innovative concept that is a logical approach to enlarging an existing testicle size in which the side by side technique would be visually problematic. Because it requires dissection of the testicle out of the scrotum there is a risk of postoperative fluid collections from peritoneal fluid leaking from the sac. Securing the implant into the implant chamber is important to try and prevent the risk of postoperative prolapse. (the testicle slipping out of the implant) 

Case Highlights:

1) One method of scrotal enlargement is implants which wrap around the existing testicles.

2) Wrap around testicular implants are indicated in average or larger sized natural testicles where the side by side technique may result in the appearance of four testicles. 

3) Prolapse is a risk of wrap around testicle implants which can occur despite various suture techniques holding them in place.

Dr. Barry Eppley

Indianapolis, Indiana

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