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Background: Saline-filled testicle implants are most commonly used for reconstructive in replacing the lost testicle due to trauma, tumors or torsion. While they do provide some bilateral fill of the scrotum they have several implant properties which are undesirable. These include a very hard feel due to the pressure of the saline in the implant shell, their size options and the need for replacement should device failure occur. (deflation)  due to failure (deflation due to disruption of the bag/shell of the implant) and limited size options. Another undesirable feature, although not one directly related to the implant, is the common use of such implants being sutured into place. This creates both a tethering effect and a palpable knot.

Some reconstructive testicle implants may eventually want replacements that solve these common problems with saline testicle implants. Ultrasoft solid silicone implants are available that have a more natural feel and, being composed of a solid material, will never need to be replaced. Standard implant sizes are available up to 5.5cms which will suffice for men seeking a normal to larger sized testicle. For those men desiring larger size, custom implants can be designed in the range of 6 to 7.5cms in size.

Some of the other improvements in testicle implant surgery include the use of a midline raphe scrotal incision. Most patients will already have a higher scrotal scar from their prior surgery but these are bypassed for an incision that is much lower and provides access to both sides though a single midline entrance site. This ensures a low implant placement. In addition suture fixation is not used or needed so the implant can hang and move without restriction. 

Case Study: This male had a prior history of testicular cancer eventually resulting in both testicles needing to be removed. He had secondary reconstruction with saline implants that healed uneventfully. But he was not happy with their size or feel. He opted for their removal and replacement with much larger solid testicle implants.

Under general anesthesia and through a midline raphe scrotal incision the saline implants were exposed and they could be seen attached to the capsule with a permanent suture. The suture and implants were removed and a subtotal capsulectomy performed…which is necessary to expand the implant pocket.

The new custom XL testicle implants (7.25cm size, 100cc volume) were opened and compared to the removed saline implants. Due to the size of new implants compared to the raphe skin incision a funnel device was used for insertion.

The before and immediate change in the size of the scrotum reflect the 2X bigger implant volumes. It will take 6 to 8 weeks after the surgery for the implants to drop down and have the soft feel. This is the expected amount of time in which the resolution of the swelling and the softening of the traumatized tissues takes to occur.

Case Highlights:

1) Saline testicle implants are what most reconstructive patients receive for their initial replacements.

2) Saline testicle implants for some men are often too small in size, feel too hard and their suture fixation can have an uncomfortable tethering effect.

3) Saline testicle implants can be secondarily replaced with larger softer solid silicone implants that are not tethered and hang lower due to a midline raphe incision placement.

Dr. Barry Eppley

Indianapolis, Indiana

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