For a patient with a small, hard, high-riding saline testicular prosthesis, replacement with a modern solid nsilicone prosthesis is often worthwhile because the problems are frequently related to the original implant characteristics and/or pocket contracture.
Common findings at surgery include:
- Thickened fibrous capsule around the implant.
- Insufficient dependent scrotal pocket.
- Fixation sutures tethering the prosthesis superiorly.
- A saline implant that feels unnaturally firm and undersized relative to the contralateral testis.
Surgical considerations:
- Remove the saline implant and perform a capsulectomy/capsulotomy
- Release the superior scar capsule that is maintaining the high position.
- Excise capsule selectively if significantly contracted.
- Create a more dependent scrotal pocket
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- Digital dissection inferiorly is often necessary.
- Some surgeons intentionally overdevelop the inferior pocket to allow postoperative descent.
- Upsize the prosthesis
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- Most patients with small older implants are happier with a larger contemporary solid silicone implant.
Dr. Barry Eppley
Plastic Surgeon