My Testicular Implant Sits Too High — Can It Be Repositioned?
A testicular implant that sits too high in the scrotum can feel unnatural, appear noticeably different from the other testicle or cause discomfort with clothing, exercise or sexual activity.
This is a recognised concern after testicular prosthesis surgery. Studies examining long-term satisfaction have repeatedly identified implant position and firmness as two of the main reasons some patients are dissatisfied with a testicular prosthesis.[3-8] In different patient series, approximately 20–39% of men reported concerns about implant position, although overall satisfaction with testicular prostheses remained high.
The important question is not simply whether the implant can be moved. It is why it is sitting high and whether another operation is likely to produce a worthwhile improvement.
Can a high testicular implant be repositioned?
Sometimes, yes.
A testicular prosthesis that remains persistently high may be suitable for revision surgery. Depending on the cause, this can involve releasing scar tissue, modifying the implant pocket, changing fixation or replacing the prosthesis with a different size.[3-5]
However, revision is not the same operation for every patient. Previous surgery changes the tissues around the implant, and scar tissue or limited scrotal space can affect how much improvement in position is realistically achievable.
You can read more about the overall options on the Testicular Implant Revision page.
Why does a testicular implant sometimes sit too high?
Several factors can contribute.
1. Scar tissue around the implant
The body naturally forms scar tissue around an implanted prosthesis. In some patients, this may restrict movement or hold the implant in a higher position.
Previous scrotal surgery, infection or inflammation can also make the tissues less flexible.[3,5]
2. The original implant pocket
During prosthesis surgery, sufficient space needs to be available within the scrotum for the implant.
If the lower part of the scrotum is tight, scarred or underdeveloped, the prosthesis may tend to remain higher.
3. Implant fixation
Some testicular prostheses can be surgically fixed in position.
Whether fixation is beneficial remains debated. A 2024 study involving 169 patients found that fixation did not prevent complaints of high implant position and was associated with more reported pain and discomfort.[4] Surgical techniques therefore vary, and the original operative approach may be relevant when assessing a high-riding prosthesis.
4. Implant size
A prosthesis that is relatively large for the available scrotal space may have difficulty sitting naturally in a lower position.
Size is therefore considered together with the position of the opposite testicle, scrotal anatomy and the amount of available tissue.
5. Previous surgery
Revision surgery can be more complicated after previous orchidectomy, prosthesis placement or other scrotal procedures.
Scar tissue can change both the available space and the way the prosthesis moves. This is one reason assessment before revision is important rather than assuming that simply replacing the implant will correct the problem.
Is a high-riding testicular implant unusual?
No. Implant position is a well-described concern in the scientific literature.
In one long-term study of testicular cancer survivors, 39% reported that the prosthesis sat too high.[7] Another study involving 171 implant recipients reported a high position in approximately 30%.[6] A US study reported that approximately 20% considered the position inappropriate.[5]
These figures should not be interpreted as predicting an individual patient's outcome. Studies involve different implants, techniques, populations and follow-up periods.
Importantly, most studies still report relatively high overall satisfaction with testicular prostheses.[3,5-8]
Will a newly inserted implant settle lower with time?
Early after surgery, swelling and temporary tightening of the scrotal tissues can make the implant appear higher than its eventual position.
For this reason, the appearance during the early healing period does not necessarily represent the final result.
The appropriate time to assess the final position depends on the operation, healing and individual anatomy. If your implant was inserted recently, your operating surgeon can advise whether further settling is expected.
Do not aggressively pull, stretch or manipulate a testicular implant unless your surgeon has specifically advised you to do so.
What happens during assessment?
Assessment usually focuses on determining why the implant is high.
This may include:
how long ago the original operation was performed
whether the position has always been high or has changed
pain or tenderness
previous infection or wound problems
the size and mobility of the implant
the amount of available scrotal space
scar tissue or tethering
the position of the opposite testicle
the condition of the overlying scrotal skin.
If available, it can be helpful to bring the previous operative report and details of the prosthesis to your appointment.
Imaging such as ultrasound is not necessarily required for every positioning problem but may be useful if examination raises another concern.
What can revision surgery involve?
There is no single operation called "testicular implant repositioning".
Depending on the findings, options may include:
Releasing scar tissue and repositioning the implant
Scar tissue restricting the implant can sometimes be released and a more dependent space created within the scrotum.
Revising the implant pocket
The existing pocket may be modified or a new pocket created to allow the prosthesis to sit differently.
Changing fixation
If fixation or tethering contributes to the implant position, this may sometimes need to be modified during revision.
Replacing the implant
If implant size, shape or another implant-related factor contributes to the problem, replacement may be considered as part of revision.
Removing the implant
If there is infection, erosion, significant tissue compromise or another important implant-related problem, removal may sometimes be preferable to immediate replacement.
Further information about first-time implantation is available on the Testicular Prosthesis Surgery page.
Will revision make both sides completely symmetrical?
Not necessarily.
Natural testicles commonly sit at different heights, and a prosthesis does not behave exactly like a natural testicle.
The achievable position after revision also depends on scar tissue, skin and tissue quality, implant size, previous operations and the anatomy of the individual scrotum.
A useful goal of consultation is therefore to establish what specifically is causing the concern and what degree of change is realistically achievable, rather than assuming perfect symmetry can be produced.
What are the risks of testicular implant revision?
Any further operation introduces additional risks.
Depending on the procedure, these can include:
bleeding, bruising or haematoma
swelling and postoperative pain
infection
wound healing problems
persistent or recurrent high implant position
asymmetry
implant migration
persistent or new discomfort
erosion or extrusion through the skin
need for implant removal
need for further revision surgery.
Published reviews describe testicular prosthesis complications as generally uncommon, but previous surgery and altered tissues need to be considered when planning revision.[3,5]
No operation can guarantee a particular final implant position or cosmetic result.
When should I seek medical assessment promptly?
A testicular implant that simply sits higher than desired is usually different from an implant that has developed an acute complication.
Seek prompt medical assessment if you develop:
increasing redness or warmth
rapidly increasing swelling
significant or worsening pain
wound discharge
fever or feeling systemically unwell
thinning or breakdown of the skin over the implant
part of the implant becoming visible through the skin.
These features can suggest infection, erosion or another complication requiring assessment.
What if the original implant surgery was performed elsewhere?
Revision can still be assessed even when the original surgery was performed by another surgeon or in another hospital.
If possible, bring copies of the original operative report and any information identifying the implant. This can help establish what was inserted and how the original surgery was performed.
Patients with more complex previous genital or scrotal surgery can also read about Penile, Genital & Urinary Reconstruction.
Take home message
A testicular implant sitting too high is a recognised reason for dissatisfaction after testicular prosthesis surgery.[3-8]
In selected patients, revision may allow the prosthesis to be repositioned by releasing scar tissue, modifying the implant pocket, changing fixation or replacing the implant. However, the appropriate approach depends on the reason for the high position and the condition of the surrounding tissues.
If the position is persistently uncomfortable or bothersome, assessment can help determine whether observation, repositioning, replacement or another approach is reasonable.
Explore:
References
European Association of Urology. EAU Guidelines on Testicular Cancer. Arnhem, The Netherlands: EAU Guidelines Office; 2026. The current EAU guideline recommends that a testicular prosthesis be offered to patients undergoing unilateral or bilateral orchidectomy and notes that implantation may be performed at orchidectomy or subsequently.
Stephenson A, Bass EB, Bixler BR, Daneshmand S, Kirkby E, Marianes A, et al. Diagnosis and Treatment of Early-Stage Testicular Cancer: AUA Guideline Amendment 2023. J Urol. 2024;211(1):20-25. doi:10.1097/JU.0000000000003694.
Matthew-Onabanjo AN, Honig S. Testicular prostheses: a historical and current review of the literature. Sex Med Rev. 2024;12(4):761-769. doi:10.1093/sxmrev/qeae055. Contemporary review of testicular prosthesis counselling, techniques, complications and patient satisfaction.
Besombes T, Suartz CV, Poinard F, Plassais C, Dariane C, Hurel S, et al. Should You Fix Testicular Prosthesis? A Satisfaction Survey From a Monocentric Cohort. Urology. 2024;184:278-282. doi:10.1016/j.urology.2023.11.017. High position remained a recognised complaint, while fixation was associated with greater reported pain and discomfort.
Clifford TG, Burg ML, Hu B, Loh-Doyle J, Hugen CM, Cai J, et al. Satisfaction With Testicular Prosthesis After Radical Orchiectomy. Urology. 2018;114:128-132. doi:10.1016/j.urology.2017.12.006. Position, size and comfort were associated with overall prosthesis satisfaction.
Dieckmann KP, Anheuser P, Schmidt S, Soyka-Hundt B, Pichlmeier U, Schriefer P, et al. Testicular prostheses in patients with testicular cancer—acceptance rate and patient satisfaction. BMC Urol. 2015;15:16. doi:10.1186/s12894-015-0010-0. High implant position was reported by 30.3% of surveyed recipients.
Yossepowitch O, Aviv D, Wainchwaig L, Baniel J. Testicular prostheses for testis cancer survivors: patient perspectives and predictors of long-term satisfaction. J Urol. 2011;186(6):2249-2252. doi:10.1016/j.juro.2011.07.075. High scrotal position was reported by 39% and was associated with lower satisfaction.
Hayon S, Michael J, Coward RM. The modern testicular prosthesis: patient selection and counseling, surgical technique, and outcomes. Asian J Androl. 2020;22(1):64-69. doi:10.4103/aja.aja_93_19. Review discussing patient selection, implant positioning, operative technique and recognised postoperative concerns.
Medical disclaimer
This information is general educational information and is not a substitute for individual medical advice, examination or treatment. Whether a testicular implant can or should be repositioned depends on the implant, previous surgery, symptoms, examination findings, tissue quality and individual circumstances. Surgical treatment carries risks and no particular cosmetic, functional or symptom outcome can be guaranteed. Seek prompt medical attention for severe or worsening pain, fever, increasing redness or swelling, wound breakdown, discharge or exposure of an implant.
