For men, there are few things that are seen so infrequently by others that can have such a direct and profound impact on their psyche as testicles. Most men do not think about their testes too often unless some illness, trauma, or congenital abnormality has left their genitals unusually small or nonexistent. An unfilled scrotum is particularly disturbing to men of all ages. Since the 1940s, testicular implants have provided the cosmetic enhancement that many of these men desperately seek. Of course the testicle prostheses are not functional—they do not create semen or release testosterone—but they serve a very important cosmetic function.
Indications for testicle implants
The most common indication for a testicle implant is in male children that were born without testes or with testes that were retained within the abdomen (undescended testes). Several other diseases of the testes can result in their destruction or atrophy (shrinkage). The testicle can become wound around its blood supply and starve the testicle of oxygen and nutrients (known as testicular torsion). Certain infections such as mumps can destroy the testes as well. Occasionally complications arising from surgery of the testes, scrotum, or inguinal hernia can result in the loss of one of both gonads.
Another common indication for testicle implants is to replace a testicle that was removed during the treatment of cancer. Testicular cancer is reasonably rare in overall frequency but is the most common malignancy in men between the ages of 15 and 35. Moreover, the principal treatment for testicular cancer is complete removal of the gonad. Therefore men in the peak of the sexual development and relationships that become stricken with testicular cancer lose a very important part of themselves. In these cases, testicular implants are usually offered and placed at the same time as the cancer surgery.
A less common indication for testicular implants is in the case of female to male gender reassignment surgery; however this is no less a reason to place testicle implants. One extremely controversial application of testicular implants is in men who simply desire larger testicles. As a profession, surgeons would not contemplate testicular implants for men that have healthy, functioning testes. In this case the natural testicle would need to be removed, leading to several medical issues, or the scrotum would be filled with larger prostheses, leading to an appealing result cosmetically. In general terms, testicular augmentation of healthy men using prosthesis is not done.
Testicular prosthesis
All sorts of devices have been used as testicular prostheses since the 1940s including marbles, metal, gelfoam and glass. However current testicle implants are made in much the same way as breast implants. Testicle implants are made of a biologically inert case filled with saline, silicone, or gel. The shape and weight of the implants are designed to simulate normal testicles. These testicle implants are surgically inserted within the scrotum between layers of tissue. This is done to achieve the best cosmetic effect and to prevent the implants from moving around the scrotum too much.
Complications of testicular implants
The most common complication of testicular implants is extrusion, that is, the prosthesis come loose. The scrotum may contract around the implant, similar in some ways to capsular contraction in breast implants. Pain, blood pooling, and infection also occur with testicle implants, but at rates that are similar to any invasive surgery.