which should be done first penile implant or testicle implants
If both procedures are planned, the penile implant (IPP) is generally done first, with testicular implants performed second, either several months later or, in selected cases, during the same operation.
The reasons are primarily anatomical and practical:
- Penile implant surgery is the more technically demanding operation.
- An inflatable penile prosthesis requires placement of cylinders, a pump in the scrotum, and (for a three-piece device) a fluid reservoir.
- During surgery, the scrotum needs to remain as mobile and unscarred as possible to create the pump pocket.
- Testicular implants can interfere with pump placement.
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- Silicone testicular implants occupy the same scrotal space where the IPP pump is positioned.
- Existing implants can make pump positioning more difficult and may increase operative complexity.
- Scarring from testicular implants can reduce scrotal flexibility.
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- While experienced prosthetic surgeons can usually work around this, virgin tissue is preferable for penile prosthesis placement.
- Pump position can influence the ideal size and location of testicular implants.
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- Once the pump has healed into its permanent position, the remaining scrotal space can be evaluated.
- This allows selection of implant size that provides the best cosmetic balance while avoiding compression of the pump.
Recommended sequence
Stage 1
- Inflatable penile prosthesis
- Allow complete healing (typically 3–6 months)
Stage 2
- Custom or standard testicular implants
- Position implants around the established pump
Can they be done together?
Yes, but only in carefully selected patients.
Advantages:
- One anesthesia
- One recovery period
Disadvantages:
- Increased operative time
- More postoperative scrotal swelling
- Greater difficulty achieving ideal pump and implant positioning
- Slightly higher risk of wound complications because more prosthetic material is placed simultaneously
If testicular implants already exist
A penile implant can still be placed. An experienced prosthetic urologist may:
- Leave the testicular implants in place if they do not interfere.
- Temporarily remove and replace one implant.
- Reposition the implants during surgery if necessary.
If the goal is cosmetic scrotal enlargement
If you’re considering large custom testicular implants (larger than standard prostheses), sequencing becomes even more important. Large implants take up substantially more scrotal volume and can significantly affect pump placement. In these cases, I would strongly favor:
- Inflatable penile prosthesis first.
- Heal completely.
- Design custom testicular implants around the final pump location.
This sequence generally produces the most predictable functional and aesthetic outcome while minimizing technical challenges.
Dr. Barry Eppley
Plastic Surgeon