A prosthetic testicle is surgically placed into a pocket created inside the scrotum and then stitched to the lowest point of the scrotal tissue using an absorbable suture. The entire procedure takes less than an hour and is done under general or local anesthesia. The implant has a small loop built into its surface, and the surgeon threads a suture through that loop and anchors it to the inner muscular layer of the scrotum, holding the prosthesis in a natural-looking position while the body heals around it.
Where the Incision Is Made
Surgeons choose from three main incision locations depending on the patient’s history and anatomy. The most common today is the suprascrotal or “wink” incision: a small, roughly 2-centimeter curved cut made just above the scrotum, a few centimeters to the side of the penis. This approach has several advantages. The incision is hidden by pubic hair, it avoids cutting directly into the scrotal skin, and it keeps the suture line away from the implant itself, which lowers the risk of infection and erosion.
A low groin (inguinal) incision is another option, particularly for patients who are having the prosthesis placed during the same surgery that removes the testicle. In adults, a direct scrotal incision along the midline is also used, especially when the implant is being placed at the time of an orchiectomy. In children, the thinner scrotal skin makes direct scrotal cuts riskier, so surgeons tend to prefer the inguinal or suprascrotal routes.
How the Implant Is Secured
Once the incision is made, the surgeon uses a finger or blunt instrument to create a pocket inside the scrotum. This pocket sits beneath a muscular layer called the dartos, which is the thin sheet of tissue just under the scrotal skin. Creating this “subdartos pouch” gives the implant a natural envelope to sit in, similar to where a real testicle would rest.
The prosthesis itself has a molded suture loop on its surface. The surgeon threads an absorbable stitch through this loop and then passes the stitch through the dartos tissue at the very bottom of the scrotum. This anchors the implant in the most dependent, natural-hanging position. The suture dissolves over several weeks as scar tissue forms around the implant and holds it permanently in place. During this step, the surgeon is careful not to push the needle all the way through the skin, since a puncture on the outer surface could introduce bacteria and increase the chance of the implant working its way out.
Some techniques also involve placing additional stitches higher up to narrow the upper part of the scrotum, which helps prevent the prosthesis from riding upward after surgery.
Materials and Sizing
Modern testicular prostheses come in several forms: solid silicone, gel-filled silicone, and saline-filled. Gel-filled silicone implants feel closest to a real testicle. Solid silicone and saline-filled versions tend to feel firmer than natural tissue, which is one of the most common complaints from patients. For saline-filled prostheses, surgeons can adjust the fill volume to change how soft or firm the implant feels. Research has found that using the lowest fill volume that doesn’t create a visible dimple in the implant produces the most realistic texture.
Implants come in extra-small through large sizes. The large size is used for the vast majority of adult patients. A medium may be chosen if the remaining testicle on the other side is smaller than average, since the goal is symmetry. Final saline fill volumes range from about 5 milliliters for an extra-small implant up to roughly 16 milliliters for a large. The surgeon typically measures or visually matches the remaining testicle to pick the right size.
Immediate vs. Delayed Placement
When a testicle removal is planned in advance, for conditions like a known absent testicle, a low-grade tumor, or benign disease, the prosthesis can be placed in the same surgery. This works well as long as there’s no excessive bleeding and the scrotal skin stays intact. Placing the implant at the same time spares the patient a second operation.
In emergencies like testicular torsion or trauma, the implant usually isn’t available on short notice, and the conversation about whether the patient even wants one hasn’t happened yet. In those cases, the prosthesis is placed in a separate procedure later, once the area has healed and the patient has had time to decide.
Recovery Timeline
Most people feel noticeably better within about a week. The first 24 to 48 hours typically involve the most pain, discomfort, and tenderness in the scrotal area. Bandages stay on for at least a few days, and a supportive undergarment helps keep swelling down and the implant stable while the tissue heals around it.
For the first month after surgery, you should avoid heavy lifting, cycling, and any strenuous physical activity. Sexual activity and masturbation are generally fine to resume after one to two weeks. By the time the absorbable sutures dissolve, scar tissue has formed a permanent capsule around the implant, keeping it in position for the long term.
Satisfaction and Potential Issues
Studies consistently find that most men are satisfied with their prosthesis and don’t regret the decision. The implant restores a normal appearance in clothing and during intimate situations, which can meaningfully improve quality of life and body image after testicle loss. The most frequent complaint is that the prosthesis feels too firm compared to a natural testicle, particularly with solid silicone models.
The main complications to be aware of are infection, pain, and extrusion (the implant gradually working its way toward the skin surface). These risks are relatively low, and the shift toward suprascrotal incisions has reduced them further by keeping the wound away from direct contact with the implant. If an implant does become infected or begins to migrate, it can be removed and, in most cases, replaced later once the area has healed.