Background: The size of the male scrotum is a function of the two testicular bodies contained in the amount of scrotal tissue and skin that surrounds them. There is no scrotal size numbers or measurements that is the right amount or the proper aesthetic size on a general basis. Scrotal size is subject to each male’s personal taste.
The most common male aesthetic concern about scrotal size is that it is too small or, more specifically, the testicles inside them is too small. There is the rare male who has normal size testicles and the scrotum around them is too small or tight. Conversely it is far more common that the testicles are too small inside a normal scrotal sac. In most cases the testicles have shrunk due to natural aging or hormone supplementation. This then creates a mismatch between their size and the scrotal skin around them in many cases.
In some cases the amount of skin is so significant that the scrotum is very lax and floppy. This creates a saggy scrotal sac (SSS) appearance which males it seem empty. This is the ideal indication for a side by side implant displacement technique for filing out the scrotum and improving its appearance. What makes it ideal is that there is adequate skin laxity to support large custom testicle implants…and…the type of skin that will allow relaxation for an eventual natural hanging appearance.
Case Study: This male had average size testicles but with a lot of lax scrotal skin. He desired testicle implants of 7.0cm size. Due to their size and the need to keep them soft feeling a hollow inner chamber design was used.
Under general anesthesia and through a low 3.5cm midline scrotal incision the bilateral implant pockets were dissected out. In so doing the natural testicles were identified and mobilized so they could move superiorly. Given the size of the implants each pocket size had to be adequate to accommodate them.
The custom testicle implants had the inner hollow chamber design in which there is a small external opening that connects to the inner chamber. The inner chamber allows for the intraoperative placement of antibiotic solutions into the implants.
Given the size of the implants compared to the incision length required a funnel insertion device for placement.
The immediate effects of the custom testicle implants was the creation of a filled scrotum that had a high and round shape which what we would expect initially due to the immediate expansion of the tissues. It will take several months for full relaxation of the tissues and the implants drop down to a more relaxed natural level.
Key Points
1) The saggy scrotal sack (SSS) is when there is a disproportion between the size of the testicles and the amount of scrotal skin around it.
2) One of the factors of the effectiveness of the side by side testicular implant enhancement technique is enough scrotal skin to accommodate sufficiently large implants.
3) In creating the implant pockets the dissection has to be sufficient to displace the natural testicle superiorly.
4) In larger testicle implants an inner hollow chamber helps maintain a soft supple feel to them.
Dr. Barry Eppley
World-Renowned Plastic Surgeon