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Background: Enlargement of the scrotum can be achieved by a variety of injection and implant techniques. An injection approach offers a no-surgical approach in which filler materials could include saline and a variety of non-permanent and permanent fillers. The most common permanent filler used, and the only one that really exists, is silicone oil. Silicone injections have been used all over the body for aesthetic purposes from the face down to the buttocks, including the penis and scrotum.

Silicone injections to the scrotum can be an effective approach of good technique is used and medical-grade silicone oil is used. But even in cases where no complications occur many patients will develop palpable nodules or firm areas which occur due to encapsulation of the silicone material. If problematic they can be treated by steroid injections which can help soften them although this frequently needs to be repeated to maintain the softening effect.

Some silicone injected patients may seek a larger and more sustained enlargement effect using testicle implants. While traditionally sized testicle implants will not suffice in this situations the use of custom testicle implants now makes such desired scrotal enlargements possible. The key question is will the multiple silicone granulomas be a problem for the placement of testicle implants? 

Case Study: This male has a prior history of silicone injections to the scrotum with known multiple firm nodules. (encapsulated silicone oil or silicone granulomas.

Under general anesthesia and through a small midline raphe scrotal incision, the existing testicles were identified as well as four hard large nodules. On opening the nodules a clear oil came extruding out. The nodules were excised and the pockets for the testicle implants developed. The existing testicles were pushed superiorly. Ultrasoft custom testicle implants of 6.0cm size were placed into the pockets, covered with antibiotic powder and a 4 layer soft tissue closure done.

The immediate effect of large testicle implants is that the scrotum will be very round and tight. It is going to take a month or two for the scrotal tissues to relax, soften and hang more naturally.

While silicone nodules in the scrotum do pose scar tissue that is not normally there, its presence does not preclude the placement of testicle implants. But when it comes to putting silicone in the scrotum there is no volumetric comparison between injected silicone and silicone implants. Even at just 6.0cms in implant size that is 90ccs of volume. In addition a silicone testicle implant is easily reversible with no adverse sequelae. Silicone injections are not easily reversible and can probably never be 100% reversed even with excision.

Case Highlights:

1)  Scrotums that have been previously treated by silicone injections can be successfully treated by testicle implants.

2) Some of the most prominent silicone granulomas can be excised as long as they are not too close to the underside of the scrotal skin surface.

3) The side by side testicle implant approach offers the least risk of complications in the silicone injected scrotum.

Dr. Barry Eppley

World Renowned Plastic Surgeon

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