Undergoing plastic and cosmetic surgery can be one of the most personal and private decisions a person can make. Yet, within the many procedures that we at Atlantic Surgical Associates perform to help patients create better lives for themselves, some are even more private than others.
Men who are self-conscious and unhappy with the size or shape of their scrotum may feel as if they have no one to talk to because the subject is so personal and private. They may keep their thoughts about their bodies to themselves, even while it makes them self-conscious in the bedroom and uncomfortable during many different physical activities such as jogging, bike or motorcycle riding or horseback riding.
Yet, scrotal reduction or tightening, also known as scrotoplasty, is a routine procedure. It treats stretched scrotal skin and muscle. It is an outpatient surgery that requires no overnight hospital stay and heals relatively quickly with great results.
It had not been very popular until late 2016, when British Telegraph published its article BALLS UP.
The Benefits Scrotal Reductions
A large scrotum can make a man self-conscious about his body and can make some physical activities uncomfortable or even painful. By tightening the scrotal muscle and skin, discomfort and irritation can be greatly reduced. Some men who before were self-conscious in the bedroom (usually due to a one time comment from their partner) often feel relieved and have more sexual self-confidence. Unfortunately, scrotum reduction surgery has become a point of ridicule on some web sites. Many web authors do not understand the reasons other males are looking into scrotal reduction procedures.
Some patients do consider the scrotum reduction for pure vanity reasons. However, many others have legitimate physical reasons to have the procedure performed despite the fact that it might not be covered by insurance.
In response to some web comments, in my experience, sexual orientation of the patients has no role in this surgery. What I did notice is that most of my scrotal reduction patients at some point in their lives were actively involved in sports and/or had previous testicular surgery.
The most common reasons I have encountered patients interested in scrotal reduction or scrotal lift surgery in my practice are:
Testicular pain and discomfort many years after varicocele or hydrocele surgery when the scrotal skin and muscle did not retract after the varicocele or hydrocele surgery and patients experience pain during exercise, intercourse or ejaculation.
Scrotal tissues get stretched out and get trapped in bicycle seat or athletic clothing.
Unrelated to surgery, excessive stretching of scrotum and relatively short spermatic cord do not allow proper support of the testicle during intercourse and ejaculation causing pain and leading to avoidance of intimacy.
An excessively stretched out scrotum may touch toilet water when scrotum relaxes, requiring patient to support the scrotum with own hand or having to squat over toilet rather than sitting down.
Self conscious patients with a younger spouse or life partner, especially if that someone made a comment regarding the scrotum.
Previous use of stretching devices. Some males felt the circumcision they had as a child resulted in a cosmetic or functional deformity. Some of them used commercially available stretching devices attempting to restore the foreskin. Unfortunately, some of them experienced stretching of the scrotal tissue at the same time.
Obviously, I do not foresee a scrotum lift or scrotum reduction surgery becoming a popular equivalent to a breast lift in women. However, as more and more men are becoming aware of this procedure, and with British media hype, at least it gives male patients an opportunity to consider available options.
About Scrotal Reduction Surgery
The surgery is usually performed on an out-patient basis using local or twilight anesthesia. It takes from 30 minutes to little over an hour depending on complexity. Neither the penis nor the urethra is affected when the scrotum is made smaller.
There are several options to scrotal surgery. The simplest way is to remove the skin only. It may work well for some but the skin may and will stretch in time.
Another option is to tighten the skin and muscle or performing Z plasty. Occasionally a small rotation of muscle or additional tissue graft is needed to reinforce the stretched and thinned out tissues. Retaining a natural shape along with all normal sensation is paramount. Self-dissolving sutures are used so you won’t have to come in just to have the stitches removed.
What are the potential risks and complications of scrotal reduction surgery?
All surgeries come with some level of risk, such as inflammation and infection. Choosing an experienced, qualified surgeon as well as strictly following pre- and post-op instructions will help to minimize the level of risk and complications. One of the possible complications of the surgery is a change in viability of the sperm. However, for most patients, this is not a major concern.
What can I expect after scrotal reduction surgery?
After the surgery you may feel a little sore for a couple of days, but both the swelling and discomfort will diminish within the first week. Ice packs can help to relieve swelling or bruising. You will need to wear an absorbent pad for the first week as well and stick to easy or light activities.
You should wait to resume sexual activity and strenuous activity for six to eight weeks. The body will continue to heal itself in the months to come and you will notice improvements throughout the first few months.
If you are considering scrotal reduction or scrotal lift surgery for yourself or your significant other, please feel free to contact our office. We understand the sensitive and private nature of this problem and we are happy to offer our services.
Incidentally, we have come across some web sites stating how simple and reliable the procedure is. Indeed, the basic scrotum reduction surgery is not complex, however, I would not oversimplify it either. Please read the answers below and I hope some of them will explain why this seemingly simple surgery has to be treated with “proper respect” and taken seriously.
Below are some of the most frequently asked questions patients have about scrotal lift or scrotum reduction surgery issues. If you have any other questions, or would like to schedule an appointment, we would love to hear from you.
Is scrotal lift or scrotum reduction surgery safe?
All surgical procedures, including a scrotum lift or scrotal reduction, are accompanied by a certain degree of risk, whether the procedures are for medical or cosmetic reasons. Our expert team is dedicated to making your operation go smoothly.
We carefully review your medical history and current health condition before deciding if it is safe for you to proceed with surgery. It is important that you fully disclose all pertinent information so that we are able to make an accurate assessment of the risks involved. We will take every precaution necessary to reduce the possibility of any complications.
How do I know if a scrotum lift or reduction surgery is right for me?
There several important factors that come into play when deciding whether a scrotum lift or scrotal reduction surgery is the right option for you. One of the most important factors is your health. Being in good health greatly reduces the risk of complications occurring during surgery and leads to a speedy recovery.
Next, you need to ask yourself what your motivations are. Those who have a scrotum lift or scrotal reduction surgery generally find that the surgery enhances their overall appearance, comfort and self-esteem.
Thirdly, you should have realistic expectations. Scrotum reduction and scrotal lift surgery is both a science and an art, neither of which are perfect. Set reasonable goals as to the result you wish to achieve and be prepared to thoroughly discuss these goals during your initial consultation.
Can I have several procedures performed simultaneously with scrotal reduction or scrotum lift surgery?
It is a relatively common practice for a plastic surgeon to perform multiple procedures during one operation. This allows the surgeon to better “sculpt” your final appearance. In addition, having several procedures done simultaneously saves you the expense of paying the operating room and anesthesia costs more than once.
However, having too many procedures performed at one time can lead to complications. The decision to have multiple procedures performed depends on which procedures are being done, the extent of surgery, the operating time, and your age/health. Ultimately, the surgeon decides whether or not it is appropriate to include more than one procedure in your operation.
Does it matter how old I am for a scrotum lift or scrotal reduction surgery?
There is no blanket rule on age although age will be taken into consideration when planning your scrotum reduction or scrotal lift operation. Men of various ages can take advantage of the physical and emotional enhancement offered by a scrotal lift and scrotum reduction surgery.
However, plastic surgery cannot “fix” every situation or reverse the aging process. What is the right procedure for one may not be an appropriate procedure for another. Depending on your age, the anatomy, size and position of your scrotum are different. Therefore your individual procedure as also determined by both your desired result and body anatomy. We are committed to making your Scrotum Lift and Scrotal Reduction surgery experience a successful one.
What happens during my initial consultation?
During your consultation we will discuss your desired changes and expectations, review your medical history and current health, and make an assessment on whether the scrotum lift or scrotal reduction is right for you. This is a good time to ask specific questions about the scrotal lift or scrotum reduction so that you are fully prepared, mentally and emotionally, for surgery.
We will discuss the results that can be achieved, possibly with the aid of photos and/or computer imaging. When a final decision is made, you will need to sign an informed consent stating that you are fully aware and understand what is entailed by your pending operation, including the potential complications and secondary effects.
How long will it take to recover from my scrotum lift and scrotal reduction surgery?
Generally, scrotal lift and scrotum reduction post-operative instructions call for rest, support and limited movement in order to speed up the healing process and recovery time. The length of recovery varies with each procedure and is different for each individual.
Bruises usually disappear within a few days, and most swelling is gone in a matter of weeks. If you follow our post-operative instructions carefully, you will be able to enjoy your normal activities within no time. Your scars will fade over time but remain permanent.
We take care to conceal any scars so that they are barely visible, if at all. When you come in for your consultation we can discuss your expected recovery period and any post-operative instructions in detail.
Will my insurance cover the scrotum reduction or scrotal lift surgery?
Insurance providers generally cover costs for reconstructive surgery but not for cosmetic surgery.
It is possible that if you have documentation of pain and discomfort that your surgery may be covered by insurance. However, most of the time they consider it cosmetic. We will be happy to assist you with the process.
How is a scrotum lift or scrotal reduction surgery performed?
There are several options for scrotal reduction or scrotal lift surgery. Most of the techniques are extensions of existing reconstructive techniques.
It is important to discuss with your surgeon the reasons for your procedure and define the desired results. When considering a scrotum reduction or scrotum lift surgery, the first question is if there is underlying medical or surgical condition involved. The main conditions we want to rule out are varicocele, hydrocele, hernia or cancer.
Cancer of the testicles is a serious condition, as you might remember, Lance Armstrong had it, and most commonly it requires surgery. Hydrocele and varicocele can also increase the size and weight of your testicles and create stretching forces to your scrotum. Therefore, these medical conditions have to be addressed first before considering scrotal reduction surgery.
Once the main medical conditions had been ruled out, we need to define the goals and determine what constitutes an acceptable result. There are several things to consider.
Are you concerned with the size of one or both sides? Are you concerned about just a height of the scrotal sac in rested position or you do not like an appearance of the scrotal sac during erection? Are there medical reasons associated with excessive stretching of the skin during erection? Do we need to correct only the sac or peno-scrotal webbing also?
Just like with any other surgery, we need to be very specific with our desired outcomes to make sure that your surgery is better tailored to your specific needs.
Some surgeons use transverse incisions to correct scrotal sagging. I prefer not to use this approach as it may create unnatural looking scar at the base. It is usually quite visible during erection. I prefer to place a scar along the raphe, or along the light line running longitudinally between the two halves of scrotal skin.
I do not like to start with Z plasty either because it distorts natural lines.
When I perform scrotal tightening, I usually isolate and tighten the muscle first and then remove excessive skin, so that the skin is not holding any weight and the support to the testicles is provided by the muscle itself.
Incidentally, the muscle commonly splits at the bottom of the stretched out scrotal sac and I find that repairing the muscle creates additional support. I believe that the skin only excision is not appropriate and it does not provide adequate longevity to the result.
Peno-scrotal webbing is a separate issue from a scrotal lift. In my experience, it cannot be corrected by duplicating a muscle as the longitudinal scar tissue may have a tendency to retract and somewhat distort the result. That is why if you require additional correction of the webbing, the associated procedure options and anticipated results are need to be discussed with the patient separately.
Overall, the options for Scrotum reduction or lift include:
Removing the skin alone
Tightening the muscle
Performing Z plasty
Sometimes it is necessary to move the muscle tissues around or place a small supporting graft
The complexity of surgery and costs are dependent upon the desired improvements, specific underlying anatomy, location of surgery – hospital or surgery center, and type of anesthesia.
How long does Scrotum Lift or Scrotal Reduction Surgery take?
Scrotum Lift or Scrotal Reduction usually takes from 30 minutes to a little over an hour depending on complexity.
What kind of anesthesia is required for the Scrotum Lift or Scrotal Reduction Surgery?
In most cases the Scrotum Lift or Scrotal Reduction surgery is performed under local or twilight anesthesia. However, some patients prefer general anesthesia.
What are the potential side effects or complications of a scrotum lift or scrotal reduction surgery?
Any surgery, including scrotum reduction or scrotal lift surgery, carries risks of complications,such as bleeding, scarring, infection, poor wound healing, asymmetry, open wound, keloid formation, chronic pains and so on.
The purpose of the muscle surrounding the testicle is to protect it from physical injury and temperature variations. Lifting the scrotum may change the muscle’s ability to position the testicle and may result in sterility or decreased viability of sperm. Hypothetically, it may also alter the production of testicular hormones.
All these side effects will be discussed with you during your pre-operative consultation. Call us today to schedule your discussion with Dr. Boris Volshteyn, our board certified plastic surgeon 732-641-3350