Testicular enhancement is an aesthetic procedure which increases the appearance of the size of the testicles and scrotum. This is different than testicular reconstruction/replacement where one or both testicles are or are about to be missing. Enhancement refers to increasing the size of the indwelling testicles, whether they are of normal size or have shrunk due to atrophy.
Testicular enhancement is done by implants that either encase (wrap around) the existing testicles or are placed side by side. (displacemcent effect) Each enhancement method has advantages and disadvantages but, when possible, the side by side method is preferred as it has the lowest risk of any complications.
The success of a side by side testicular enhancement technique, and the avoidance of a ‘4 ball sac’, is the size of the implants place. I have seen numerous patients who have had the side by side implant technique done, but because only standard implants were used, the equal appearance of the testicles and the implants occurred. The key to success is that the implants must be substantially larger than the natural testicles, at least 50% larger and closer to 75% if possible. This requires custom made implants made of an ultrasoft solid silicone material. If most testicle implants are around 3.5cms in size 6.0 or 6.5cm implants should be used.
With larger implants the goal is to displace the natural testicles ‘up and away’. This occurs because the testicles are attached by a neurovascular cord and are naturally drawn upward towards the upper half of the scrotum. Conversely implants placed into the scrotum are free of any such attachments and will drift downward to fill out the lower scrotum as well as adding fullness to the entire scrotum. With large enough implants the natural testicles become hidden due to this displacement effect. This doesn’t mean they may never be seen with certain manipulations but it would be infrequent and appears as more of an isolated soft mass rather than an obvious testicle shape.
The other criteria for aesthetic success in this approach to testicular enhancement is the smaller or more atrophiic the testicles are they better the result will be. Thus men who have true testicular atrophy caused either by age or drug effects (testosterone) get the best results.
Dr. Barry Eppley
World-Renowned Plastic Surgeon