Introduction
A silicone testicle implant is a soft, solid, medical-grade silicone prosthesis placed inside the scrotum to replace a missing testicle or to enhance testicular volume.
They are commonly used for:
- Cosmetic testicular enlargement
- Post-orchiectomy replacement (cancer, torsion, trauma, undescended testicle)
- Gender-affirming surgery (GAS)
- Correction of congenital asymmetry or atrophy
These implants are solid, not gel-filled—meaning:
? They cannot leak
? They hold shape
? They feel soft but firm, similar to a natural testicle
Implant Types & Sizing
Material
- Soft-solid silicone elastomer
That is the modern standard—durable, natural, and safe.
Shape
- Oval / anatomical
- Round (less common)
Sizes
Typical factory sizes range from 2.5–5.0 cms with implant volumes from 6 to 40ccs. Larger sizes require custom designs for:
- Extra-large augmentation
- Specific asymmetry correction
- Custom dimensions for more natural fit
Why Silicone Over Saline?
- Saline implants have a firmer feel that many men do not like.
- The valve on one end of the implant is palpable and often even visible through the skin/
- Between the valve handle on one end of the implant and the suture placed through it for implant fixation it lacks mobility, can sit too high in the scrotum and may be a source of discomfort.
- Failure or deflation of a saline implant may occur requiring replacement. Silicone implants can not fail and never need to be replaced
Are They Safe Long-Term?
Yes. Silicone elastomer testicle implants are considered medically safe and durable, with many lasting decades if placed properly.
Case Study
This older male had congenital anorchia and initially had very small testicle implants placed as a child. Decades later as an older male he had medium saline implants placed. (15 years proper to today) He never liked the size, feel and high position of them. He never felt they looked or felt natural. He opted for the largest standard silicone implant size. The size of the implants were small and the valve on one end could clearly be felt and seen.
Under anesthesia through a small low scrotal incision this silicone implants were exposed and, as it is very typical, there was a search or fixing them into place. The saline implants were removed and capsulotomirs were performed to expand and lower the implant pockets. A midline septum of tissue was maintained between the two implant pockets.
Comparing the removed 4.0 cm saline implants to the replacement 5.0cm silicone implants their size and shape differences could be clearly seen. Also, the increased softness of the larger silicone implants under compression compared to the firmer smaller saline implants could also be appreciated.
The replacement silicon implants were inserted, packed with antibiotic powder, and then closed in four layers with resorbable sutures. The small scrotal incision could barely be seen at its inferior position.
Discussion
While saline testicle implants are perfectly safe the implant design concept poses several aesthetic problems. And this is not so different then what one sees with saline breast implants… the only other aesthetic body implant which is saline filled. Based on the implant design there is going to be a fill valve on the implant which for testicle implants is on one of its ends. In addition the fill valve has been designed with a handle for suture placement. Together these implant features make it both palpable and often visible as well. When this is combined with the firmer implant feel and being immobilized by suture fixation this can create an undesired feel and appearance to the implants in the scrotum.
Well none of these undesired features of the saline testicle implant poses any medical issues it does create various aesthetic concerns. Most of these aesthetic issues are overcome by the use of a completely smooth and softer silicone testicle implant. The ones that are not overcome by implant design are done so by surgical technique. First and foremost there is no benefit to suturing a testicle implant inside the scrotum. Fortunately with a silicone implant this is not possible anyway. Secondly coming from a lower scrotal incision allows the pockets to be developing in the most inferior position as possible as opposed to a high scrotal or inguinal approach. With rare exception no patient ever said their testicle implants sit too low. Conversely patients are almost always concerned about implants riding too high up into the scrotum. Avoiding this problem is not an implant design issue per se but rather the incisional approach and how the implant pockets are created.
Key Points
1) Saline testicle implants or not infrequently associated with an undesired appearance and feel due to the physical characteristics of the implants as well as how they are place.
2) Removal of existing testicle implants for larger size replacements that have a lower position in the scrotum requires capsulectomies and pocket expansion.
3) Silicone testicle implants have the advantage of long term durability and a softer more natural appearance.
Barry Eppley, MD, DMD
World-Renowned Plastic Surgeon