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Background: Testicle implants have a fairly long history of clinical use and their compositions have evolved over this time period. Like almost all aesthetic body implants they have their origin as either a solid or silicone gel-filled oval shaped implant. They had a tab on one end to serve as a point of suture fixation during placement. With the silicone gel breast implant induced moratorium by the FDA in 1991, silicone testicle implants went the way of breast implants and became no longer commercially available. They were eventually replaced by saline-filled testicle implant styles which remain today as the most commonly used testicular replacement device.

Despite their common use saline-filled testicle implants are not without aesthetic liabilities. A certain percentage of saline implanted men complain of how hard they feel, usually with a concomitant issue of being too small as well. While the suture fixation of testicle implants seem like a logical technique it is actually counterproductive to the end result of a mobile and low hanging implant in the scrotal sac.

When men present with devices that were placed decades ago, in the US or around the world, one never knows what will be found in this walking history museum of testicular implants.     

Case Study: This male in his 60s presented for the replacement of a left testicular implant placed back in 1992. He did not have a problem with its size but he had never liked how hard it felt since the day it was put in. (30 years ago)

Under general anesthesia and through a midline scrotal raphe incision of 2.5cms length, the left testicle implant capsule was found and opened. It could be seen that this was a solid silicone implant. It was attached by a suture which was adherent to the implant capsule.

On its removal it was compared to the 5.0cm standard solid testicle implant replacement. On a digital compression test the removed implant was a lot stiffer than the new replacement.

This older solid silicone implant represents limitations of manufacturing at that time. Solid silicone implants today have a much softer feel due to the use of a lower durometer silicone. While gel-filled silicone breast implants have gone in the opposite direction of making their material more cohesive (higher durometer), solid silicone body implants have now been designed to be less stiff or with lower durometers. To make an analogy to modern day breast implants it would be fair to call them Gummy Bear Testicle Implants based on how they feel. 

Case Highlights:

1) ‘Ancient’ testicle implants, regardless of their composition, are always firmer in feel than contemporary testicle implants.

2) Most older testicle implants will have a suture fixation pot which contributes to their more restricted movement or tighter feel. 

3) Provided size requests are to just match that of the opposite normal side a standard ultra soft gummy bear testicle implant will suffice.

Dr. Barry Eppley

Indianapolis, Indiana

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