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Background: The testicles are the major component of the scrotal sac whose sole function is to contain them and help regulate their temperature for viable sperm production. But beyond this function their aesthetic value is in their size which adds volume to the skin sac. The normal testicle size ranges from 3.5 to 5.5cms in length and 2 to 3.5cms in width. These sizes create volumes from 15 to 35ccs.

The aesthetics of testicle size is open to personal interpretation but the vast majority of men either give it little thought or are content with these normal size ranges. But some men prefer testicle implant sizes that are beyond these size and volume ranges. An implant is the only way to effectively do so and they have to be custom made as the maximum standard implant size is 5.0cms. As sizes become north of 5.0cms the implant durometer alone may not be enough to keep it soft and variations in their designs have been done to do what the structure of the material can not do.

One unique feature of large and extra large testicle implant sizes is the stretch that it creates on the scrotal tissues. At these larger sizes the expansion of the scrotum will make it feel unnatural. (high and tight) Patients understandably ask about whether it will ever relax and how long does it take to do so. While that answer is affected by the variables of implant size of the implant and how tight the scrotum sac was initially, the answer is it will but it takes months of time to do so. 

Case Study: This male had indwelling testicle implants of maximum standard size.(5.0) and desired a larger size. These were replaced by 7.0cm ultrasoft solid testicle implants and he went on to heal uneventfully.

Eighteen (18) months later he returned for larger implants of 8.5cms in size. Because of the larger size even ultrasoft silicone can feel more firm than desired. To ensure as soft a feel as possible these XL implants were redesigned with a hollow inner chamber.

With these XL implants the scrotum was definitely ‘high and tight’ and form to the touch.

When seen eight (8) months later for a different aesthetic procedure the scotum was soft, had a more natural hang and the implants were very mobile and not overly firm.

Like aesthetic implant size increases anywhere on the body  a tissue expansion effect does occur. So the question is not whether larger implants can be placed but how will they feel and look. The scrotum tissues are thin and easily expanded but will the implants drop and have a non-firm feel. (I wouldn’t use the term ‘natural’ feel since there is nothing natural about testicle implants of this size) Since tissue expansion has a 3D effect it is expected that this tissue relaxation and implant drop will occur. But it is a process that takes time and there is a good corollary from other aesthetic implant procedures (e.g., breast implants) where a significant difference in the look and feel of the augmented tissues from the first few weeks after surgery until two to three month postop.

Key Points:

1) The scrotum can be sequentially enlarged with testicle implants for large size increases.

2) Large testicle implants expand the scrotal tissues making it initially ride high and tight that takes months of time to relax and settle.

3) Long term followup shows that eventual relaxation of the scrotum occurs and a more natural hang develops.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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