Testicular implants can simply and aesthetically assist in cases of loss or the lack of development of one or both testicles. Besides the actual cosmetic handicap, these cases can also cause secondary psychological problems and feelings of inferiority in affected men. Usually these are young men, so when the surgical procedure is requested and technically possible, it can be done. Based on availability, harmlessness and the quality of testicular prostheses this procedure should be offered at every experienced plastic surgical clinic.
There are a variety of diagnoses where testicular implants treatment may be suitable. These include cases following injuries with the need for orchiectomy (removal of testicles;) a cancer diagnosis with the need for funicular orchiectomy (removal of testicle with spermatic cord;) an undescended testicle with the need for removal of an inborn undeveloped testicle and so on. The relative indication indicts the state of hormonal treatment (for example, a double orchiectomy within treatment of prostate cancer) or cases associated with the loss of both testicles combined with sexological and psychiatric treatment.
Silicone, respectively gel implants are used. These are practically identical to the more commonly known breasts implants. Most of the producers create products with a real shape and feel. They are offered in about five sizes indicated in cm or cm3. The implants are usually equipped with a fixation loop to prevent a shift towards the inguinal canal (groin). Some producers make two types of surfaces – smooth and rough. The package is sterile, with the sterility indicated, and no preparations are needed. The products are naturally certified with an identification label for the implant carrier.
We choose an inguinal or more often scrotal (from the area of scrotum) approach. The inguinal approach is mainly used in urological departments. Those are planned surgeries because of tumors. Here it is necessary to remove the testicle with the spermatic cord directly from this higher incision. The same approach is used in an insertion of an implant after removing an inborn underdeveloped inferior testicle in the area of inguinal canal. The advantage of this approach is the possibility of inserting the prosthesis at the same time as the original procedure. The disadvantage is a poor chance to create enough room for the testicle in the scrotum and the impossibility of using a fixation loop for the implant. The incision between the scrotal cavity and groin must be closed with a circular suture.
The second approach, the scrotal, is used in all other cases of the indications mentioned above. Those are mostly cases when it was not possible to insert the implant during the original procedure. The advantage is the possibility of a good preparation of the cavity in the scrotum for implant insertion and the likelihood of a good attachment to the dermis of the scrotum.
The procedure is performed under main or a short general anesthesia; it is usually an out-patient procedure. After deciding on the right approach, an incision is made. The length depends on what is necessary for inserting the implant into the scrotum. Then we usually make room for the prosthesis with a blunt preparation. The implant is inserted under strictly aseptic conditions and is fixed with one of the possibilities mentioned above, so that the position and height of the implant look natural. Then we close the dermis with absorbable material; the epidermis usually with non-absorbable sutures. The wound is covered sterilely. The intra-dermal suture is removed after approximately seven days.
There are a number of advantages to this procedure. It is a simple procedure, it can be done as an out-patient, the shape and feel of the implant is real, the client has the possibility to choose the size, nearly all patients are able to tolerate the procedure, the implant is easily obtained and the price is not too high.
There is a slightly fixed position to the testicle in the scrotum compared to the other side and there won’t be any natural reaction to temperature changes.