Testicular enhancement, or the enlargement of one’s testicles, can be done by one of two implant methods. The most logical one is the encasement of the testicles with a wraparound implant. One’s natural testicle fits inside the wraparound implant who’s external diameter is the size one desires. While conceptually appealing it has no complications of secondary disengagement which could occur anytime after their plantation from months to years later. This is a particular risk the smaller the natural testicles are. The other approach is to place much larger implants along with the natural testicles which will displaced them superiorly and largely out of you. The success of the displacement method depends I’m having implants that are sufficiently larger than the natural testicles to become the dominant structures in the scrotum.
Regardless of the testicular enhancement method used one intraoperative technique that applies to both is to maintain a strip or septum of tissue between the implants. While the implants will naturally form their own enveloping capsule of scar they will not do so if the implants are initially placed side-by-side with no intervening tissue. When placed side-by-side with no tissue separation between them they will form one large capsule in which both implants will reside. It is not clear whether this increases the risk of postoperative complications particularly chronic seromas. But the two natural testicles are kept separated in their own tissue compartments so it would be ideal if any implant placements did also.
In that regard it is important after making the initial midline scrotal incision that further dissection sharply go to the left and right. Then by blunt dissection each implant pocket can be created. In so doing the natural testicles will be encountered. Enough dissection should be done around them to ensure that they are free to move up superiorly. In creating these bilateral implant pockets the goal is to maintain a strip of tissue between them. This septal separation may be thin, and it is unsure if it will survive by the pressure of the two implants between them, but at least an effort should be made for its preservation. The large custom testicle implants are then inserted, sometimes with the use of a funnel device.
After the placement of antibiotic powder the initial closure consists of a tissue layer over the implants which are attached centrally to the midline tissue. A layered closure is then done up to the skin level with at least two layers of resorbable sutures. The skin is then closed with a running 5-0 plain suture and then covered with surgical glue to act as a sealant.
The placement of the implants causes some immediate tissue expansion and stretch. That combined with the swelling makes the implant initially high and unnatural feeling. It will take months for the implants to settle and relax for a more natural appearance. The preservation of the tissue between the implants will not expedite this process but hopefully long term it is better to have to separate implant pockets then to have one large implant with the implants rubbing against each other.
Dr. Barry Eppley
World-Renowned Plastic Surgeon