Top Articles

Testicular implants are the smallest aesthetic body implant. Despite its small size it shares several features to that of another body implant that is far more commonly used, breast implants. The similarities may not seem obvious and the implant compositions are different. (testicle implants  are soft solid implants while breast implants are soft gel-filled implants) But what they share is that both are meant to be compressible implants that permit and have to have mobility. (soft and supple) In fact testicle implants have to have even greater mobility given that they are in a containment sac which allows them to hang low.

But with any freely mobile implant it is necessary to have the body develop a thin surrounding scar capsule. With a thin capsule the implant remains soft and compressible. But capsular pathology is well known to occur in breast implants in which the capsule becomes thick which results in a firm feeling implant that is immobile, a well known phenomenon known as capsular contracture. While not commonly seen or reported in testicle implants there is no reason why it could not occur.

While a firm or hard testicle implant is most commonly due to the implant, composition (saline-filled implant or old style solid silicone implants), there are instances where not is due to the surrounding capsule. While testicular implant contracture has been rarely reported, how to treat it is even more rarely known.

Treating the capsule of a testicle implant can be done by either a capsulectomy (removal) or capsulotomy. (release) To do either one the implant is first removed and then the capsular lining is everted outward and placed under tension. The best access to do this is a midline raphe incision. (which hopefully is how they were originally placed) Using electrocautery the capsule is initially scored for release and a grid pattern created which working around 360 degrees inside the pocket.

Once the capsule is completed scored it can either be left as is, some of the capsule removed or the entire capsule is removed. The choice will depend on how significant the capsule contracture was. As a general rule it is always a good choice to just take the time and remove the entire capsule. This will ensure the most thorough relaxed and expanded pocket for the implant.

In my experience the most common reason for a testicle implant capsulectomy is when doing implant replacement, particularly when a much larger implant is being placed. Pocket space needs to be created to accommodate the increased implant size. Not doing so risks having a desired larger implant size but one that feels firm with inadequate hang.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

Top Articles