Testicular Implants
Testicular implants are soft silicone shapes placed into a scrotum built by scrotoplasty. They give the pouch weight and outline, and that is all they do. They make no hormones and change nothing about how anything works. They are the same implants used for cis men who have lost a testicle to cancer or injury.
They are nearly always a separate, short procedure some months after the scrotoplasty, once the skin has healed and stopped changing. The operation is minor. The decision that matters is size. A scrotum made from labia has less stretch than one that grew that way. An implant too big for the skin over it is the most common reason one ends up pushing through.
This is the optional second step, and a fair number of people never take it. Of the men I have walked through meta and phallo in Bangkok, a good share were happy with the empty scrotum and stopped there. I cannot think of one who regretted waiting.
At a glance
- Also known as
- Testicular prostheses, scrotal implants, testicular prosthesis insertion
- Surgery time
- About 1 hour
- Anaesthesia
- General, or local with sedation
- Hospital stay
- Outpatient
- Back to work
- About 1 week
- Full recovery
- 6 weeks; implants settle over 3–6 months
- Scar
- One short line at the top of the scrotum or along the raphe
- Sensation
- Unchanged; the implants sit under skin that keeps its nerves
- Typical cost
- $5,000–$12,000 (United States, self-pay)
- Usually preceded by
- Scrotoplasty
Figures reviewed .
On this page
Who it’s for
Anyone with a healed scrotoplasty who wants the scrotum to look and feel full. Most surgeons want six months or more since the scrotoplasty. They want skin that is fully closed with no thin or scarred patches, and a pouch big enough to take the implant without tension.
Wait if the scrotum still has any open area, if the skin over one side is thin or tight, or if you are between other operations. An erectile implant planned for the same region affects timing, because some surgeons place both together and others keep them apart. And if what you want is the shape rather than the feel, an empty scrotum may already be giving you that.
Nicotine matters more than the size of the operation suggests. The skin over the implant has to heal cleanly with a foreign body underneath. See eligibility.
Before you book
Live with the empty scrotum for a full six months first and notice whether you still think about it. If you do, book; if you've stopped noticing, you may already have what you wanted.
How it’s done
Under general anaesthetic, or local with sedation at some clinics, the surgeon makes a short incision at the top of the scrotum or along the raphe, the natural seam down the middle. It sits well away from where the implant will end up. They open a pocket down into each side of the pouch, slip a sized implant into it, and close the incision in layers. Some stitch the implant to the tissue at the bottom of the pocket so it cannot ride up. There is no catheter and no drain, and the whole thing takes about an hour.
Sizing happens on the table with trial implants, or is settled at the consultation from the room the scrotum has. Most surgeons place a size smaller than the patient asks for. If the skin stretches over the following year, a size up is a simple exchange. Taking out an implant that has worn through the skin is not.
At the consultation
Ask what size they'd choose for you before you say what size you want, and ask why. The answer tells you whether they're sizing to your skin or to your wish list.
Testicular implants recovery
Sore and tight for about a week, with the scrotum feeling stretched around something that was not there before. Supportive underwear helps more than painkillers. Most people are back at a desk within a week and avoid cycling, heavy lifting and sex for about six weeks.
The odd part is that the implants start high and drop over the following months as the pocket relaxes. What looks wrong at week two often looks right at month three, so wait before judging position.
| Day 0 | Home the same day. Supportive underwear on. Swelling starting. |
|---|---|
| Week 1 | Tightness and soreness easing. Desk work. Implants sitting high. |
| Weeks 2–3 | Incision healed. Swelling down. Any redness or warmth here needs a call to the surgeon. |
| Week 6 | Full activity, cycling and sex return. |
| Months 3–6 | Implants settled into their final position. Size-up, if wanted, considered from here. |
In the first month
Wear the supportive underwear day and night for the first couple of weeks, even to sleep. Letting the implants hang early is the single thing surgeons say makes the soreness worse.
Testicular implants scars
One short line, a few centimetres long, at the top of the scrotum where it meets the base of the phallus or hidden in the raphe down the middle. Either way it sits in a crease and fades to a pale line within a year. The scrotoplasty scars do not change. There is no donor site.
Sensation after testicular implants
Unchanged. The implants sit in a pocket beneath skin that keeps the nerves it had, so touch on the scrotum is the same as before. The pocket itself has no feeling. Some numbness around the incision is common for a few months.
Risks and complications
Extrusion is the one to know about. It means the implant working its way through the skin and out, or gets close enough that it has to come out. It is more likely with an implant that is too large, thin or scarred skin, placement before the scrotum has fully healed, and smoking. Infection is the other early risk, and it nearly always means removing the implant and waiting several months before trying again.
Later problems are about position. An implant that drifts upward, sits higher than its pair, or turns and feels the wrong shape. A shell of scar tissue forming around one can make it feel hard. Chronic discomfort is uncommon but real, and a small number of people have the implants taken out for that reason.
The risk that belongs to this step and not to the scrotoplasty is the foreign body itself. An empty scrotum has almost none of these problems, which is why some people stop before this step.
Testicular implants results
A scrotum with the weight and outline of testicles. It hangs and moves, and passes to the hand in a way an empty pouch does not. Most people are satisfied with the look. The feel is firmer than testes and does not change with cold or arousal. In many people the implants sit slightly higher and closer together than natural testes.
Implants are permanent unless they are removed. Some people exchange for a larger size once the skin has stretched. Some have one or both removed after extrusion, infection or a change of mind. What tends to disappoint is asymmetry, and the surgeon can usually fix that with a small revision.
Alternatives to testicular implants
The alternative is to stop after the scrotoplasty, and it is more common than the surgeon websites suggest. An empty scrotum has shape and hair and sensation and none of the extrusion risk. If you are unsure, wait; the scrotum keeps changing for months and implants can go in at any point after it has settled.
Combining testicular implants with other surgery
Some surgeons place testicular implants in the same operation as an erectile implant or a phalloplasty revision stage to save an anaesthetic. Others keep them apart, because an infection in one implant can reach the other and cost you both. Ask which your surgeon prefers and why.
Testicular implants cost
Nearly always quoted separately from the meta or phallo. Check whether the figure includes the implants themselves, the anaesthetist and the facility, or the surgeon's fee alone. Ask what happens if an implant has to come out for infection or extrusion, and whether the replacement is charged in full.
Insurance is less reliable than for the surgery that came before it, because some plans class implants as cosmetic even where they covered the phalloplasty. In Thailand the implants are usually a line item on the package, and a size-up later is a second small charge.
| Country | Self-pay | Public / insurance |
|---|---|---|
| United States Both implants and the procedure; sometimes bundled with an erectile implant | $5,000–$12,000 | Inconsistent; some plans cover it inside the genital surgery, others class it as cosmetic |
| Thailand Often a line item on a meta or phallo package; plan a week in Bangkok before flying | $2,500–$6,000 | Self-pay only for international patients |
Choosing a testicular implants surgeon
This is a small operation, so the surgeon is usually whoever did the scrotoplasty. The two numbers I would ask for are their extrusion rate and how many patients have needed an implant removed. I would want a figure rather than a reassurance.
Then ask what size they would put in you and why. A surgeon who talks about the skin and the room in the pouch before the size you want has seen an extrusion. That is the one you want. Ask to see healed photos at six months, when the implants have dropped, rather than the week-one photos where everything sits high.
Before you book
Ask whether they stitch the implant down at the bottom of the pocket, and what they do when one rides up. Implants sitting high and uneven are the commonest reason people come back unhappy, and a surgeon who has an answer ready has fixed a few.
Frequently asked questions
What size should I get?
Smaller than you might want. The scrotum has limited stretch and larger implants push through more often; a size-up later is easy, an extrusion is not. See how it's done.
Do they need replacing over time?
No. Unlike an erectile implant there are no moving parts and nothing wears out. They stay in unless they extrude, get infected, or you want a different size. See results.
Do I need them?
No. They are cosmetic, and plenty of people stop after scrotoplasty. See alternatives.
Will they feel like real testicles?
Close to the hand, firmer to you, and they do not move with temperature or arousal. See results.