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Background:  Testicular enhancement is a different implant technique than testicular replacement. In the latter the implant acts to replace a testicle that has been lost. Conversely in testicular enhancement the native testicles remain present nd the goal is to make them appear bigger. To do so two methods exist, a wrap around implant and a side by side displacement implant. Each approach has its merits but the disadvantage of the wrap around implant technique, albeit partial or complete, is the risk of secondary disengagement or separation. (which is not rare)

The side by side implant method does not have the risk of disengagement from the native testicle since it is a solid implant and merely lies next to it. But it does have the risk of native testicle show if the displacing implant is not big enough. When this occurs there will be the appearance of four testicles, the pair of native testicles and the pair of implants. This undesired scrotal appearance can be avoided by placing large enough implants that they satisfactorily displace the native testicles out of the way and in a more hidden position inside the scrotum behind/above the implants.

The increase in size that the implant must be over that of the native testicles is a minimum of a 50% increase and preferably 75%. Assuming that the average testicle that has lost volume is no bigger than 3.5cms (and often less) this means that the minimum size implant should be 5.5 to 6cms. (6.5cm is even better) Given that the largest off the shelf standard solid silicone testicle implant is 5.0cms to be successful the side by side enhancement technique requires a custom made silicone implant.

Case Study: This male had a prior history of 5.0cm silicone testicle implants placed for an enhancement effect by displacement. They were placed through through lateral scrotal incisions. Unfortinately, but predictably, a 4 pack aesthetic results ensued.

Under general anesthesia and through a midline raphe incision the indwelling implants were removed. The pockiest were enlarged and new custom 6.5cm silicone implants were inserted.

After closing their independent implant capsules, the midline dead space was closed in four layers up to the skin. This is a key maneuver in the midline raphe approach with implant placement to both keep the two implants separate but also to prevent a space for postoperative fluid collection and increase the risk of infection

The immediate improvement in the appearance of the scrotum from a four pack to a more normal two pack could be seen.  

Case Highlights:

1) One form of testicular enhancement is the placement of larger testicle implants side by side to the native testicles as a displacement method.

2) The key to the side by side testicular technique is to have implants that are 50% to 75% larger than the native testicles…which always means they must be custom made. If not a ‘4 ball’ appearance will result.

3)  When placing larger testicle implants for a displacement effect the inferior midline raphe incisional approach works best.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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