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Background:  Testicular enhancement is an aesthetic approach to increasing the appearance of the size of the testicles. Conceptually this could mean actually increasing the size of the testicles directly by placing implants around them or placing an implant that assumes the appearance of new larger testicles. Historically the direct implant approach to testicular enlargement has been the technique used. It is certainly the most logical approach and it has its merits.

The implant displacement technique has been rarely used historically because of the limitations of implant size. With the largest standard testicle implant being 5.0cms this would be an inadequate choice to aesthetically camouflage any natural testicle implant size. This has certainly been tried by some surgeons and I have seen numerous examples of the result of that approach…the appearance of both the natural testicles and the implants. (4 testicle appearance)

With custom testicle implant designs, however, the displacement method becomes viable. As any implant size can be designed and manufactured it is only question of what is the minimum implant size that is needed. What implant size and volume is needed to sufficiently camouflage the natural testicles?     

Case Study: This middle-aged male desired to have larger testicles and wanted the side by side implants technique to achieve it. His natural testicle size was 3.9cms, may be a bit less. He opted for specific 6.6cm size implants, a near 70% size increase.

Under general anesthesia and through a low 3.5cm long midline raphe incision bilateral implant pockets were dissected out in the thin tissues of the scrotum. The testicles were identified and pushed in the dissection superiorly and posteriorly as much as possible. The implants were placed on each side with the hardest part being to keep a midline septum of tissue. A four layer resorbable suture closure was then done.

With the amount of loose and empty scrotal tissue placement of the ‘large’ testicle implants was not an issue in terms of space and tissue stretch.

The side by side implant enlargement method, which implies a horizontal (east-west) displacement is really a vertical (north-south) displacement. As the natural testicles are attached by a neurovascular cord and the implants are not and are capable of descending as healing proceeds and the scrotal skin relaxes from the initial stretch, there will be a north-south orientation of the testicles and implants.

In my experience to date I have used the 70% to 75% increase of implant over testicle size to serve as the minimum needed to have the implants become the new testicle appearance. (and camouflage the existing testicles) While there is no exact mathematical formula for determining how much implant volume is needed for this displacement effect I am fairly certain that any size less than a 50% increase will not be effective.

Case Highlights:

1) The side by side testicular enhancement technique depends on having a pair of implants that can satisfactorily disguise the location of the natural testicles.

2) A good rule to follow for custom testicle implant design is that a 75% increase in size over the natural testicles is needed.

3) A low midline raphe scrotal incision equal to the width of the implant can be used for bilateral placement.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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