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Testicular enhancement refers to making the existing size of the testicles larger. The testicles remain in place but their size appears bigger. There are multiple aesthetic procedures to try and achieve this effect from injectable materials to implants. While implants produce the most consistent and assured effect there are two methods to do so. The most logical approach is a wrap around implant that makes the existing testicle bigger directly. While appealing this approach has a high risk of postoperative separation from the testicle and has fallen into disuse in my practice.

The most common technique that I use today is a displacement method which creates testicular enhancement indirectly. Rather than enlarge the testicles by placing an implant around them, implants are placed next to the testicles as a side by side method. While counterintuitive the key to success with this approach is that the implant must be much bigger than the natural testicle. If the implant is big enough it will push the natural testicles up and back as they are attached by a neurovascular cord and can’t go lower or to the sides. As a result the implants will become the most visible feature in the scrotum.

The obvious question is how much bigger does the implant have to be for a successful displacement. At the least a 50% increase is needed but experience has shown that a 75% increase is the most assured amount that the risk of natural testicle show is significantly reduced/eliminated. 

While this testicular implant displacement method is not new I have seen a few patients who have come to me where this has been done and they now have a ‘4 ball’ appearance. This occurs because the implants used are either same size as that of the natural testicles or are only marginally bigger. The error in this patients is that the surgeon used standard testicle implants. With standard testicle implants the largest size is 5.0, which while bigger than the standard male testicle size which averages 3.5cms, is only about a 40% size increase…which is not enough to prevent natural testicle show.

It takes custom testicle implants of larger sizes for the displacement enhancement technique to be successful. This is why in most cases the typical implant size is in the 6.0 to 7.0 size range.  At 6.0 size the increase is 71% and at 6.5 size the increase is 86% using a natural testicle implant size of 3.5cms.

It is important to realize that a standard implant has been developed and used for standard problems…in this case as a replacement for a lost or absent testicle. Testicular enhancement, however, is not a standard surgery and as a result it is no surprise that the use of standard implants does not work. Custom implant designing is what is needed for an innovative solution to a ‘new’ problem’.

Dr. Barry Eppley

World-Renowned Plastic Surgeon

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