Custom designed implants offer the capability of a much larger testicle size than what one has naturally or can be achieved with any standard implant. But as the implant size ascends above the maximum standard dimensions of 5.0cms the scrotum is going to get tighter from the increase in implant volume. This will be of particular significance as the implant side becomes in the 6.0 and 7.0cm range. (obviously higher volumes in the 8.0cm and greater this is even more so but these sizes are uncommon)
With the placement of such larger implants for which the scrotum was not initially designed to accommodate, there is going to be an immediate ‘high and tight’ feeling. This is to be expected and is not much different than the female who undergoes breast augmentation…the implants will initially look high and tight. As a result an obvious patient question and concern is will they ever drop and feel more natural.
The answer is they do but it will take time. (usually a full three months after surgery) There are several anatomic elements that ensure this will happen to some degree. The scrotal tissues are thin so they have a great capacity to stretch and their natural wrinkly appearance is a testament to that feature. Since the implants are placed through a low midline scrotal incision and are not sutured into place they are always going to drop lower and get softer that how they appear early after surgery. Whether they achieve a completely natural look can be debated as it is important to remember there is nothing natural about testicle implants at these custom sizes.
How soon they drop and to what extent depends on numerous scrotal skin characteristics. The more lax the scrotal skin initially is, lack of prior testicle/scrotal surgery and smaller implant sizes all play a role in contributing to earlier descent and a softer feel. the tighter the scrotal sac is, prior surgery with external skin scars and larger implant sizes mean that it will take more time for whatever relaxation is gong to happen to occur.
There are well known ‘ball stretching’ maneuvers and devices to help the implants and the scrotum move along to the relaxation phase sooner and perhaps end up better than they might on their own. But whether these are rings, straps or weights I would start to use them until 6 weeks after the surgery when the risks of causing incisional dehiscences and implant seromas have passed.
Dr. Barry Eppley
World-Renowned Plastic Surgeon