Scrotal implants are stainless steel, nylon, or other beads or objects implanted inside the scrotum, typically to either replace missing testicles, or to enhance the appearance of the scrotum with larger balls. Silicone testicles ("falsies", for example under the brandname Neuticles in the veterinary field) are sometimes used, especially when a natural testicle appearance is desired after castration.

A small number of doctors use "cupped" implants which actually form a sheath around the testicles, but most doctors prefer to implant a second larger set of testicles beneath the real ones in the interest of safety.

First of all, it should be noted that the most current and thorough risk information is cataloged in BME/Risks at
http://www.bmezine.com/risks/

The largest risk is infection, primarily in the time period immediately following the procedure. Again, bacteria trapped inside the scrotum can quickly grow to become a life-threatening infection, literally overnight. Additionally, in cases where heavier implants (for example, things like 2" steel balls) are used, tissue death surrounding (especially below) the implant has been reported, leading to scrotal amputation after gangrene set in.

It goes without saying that using proper medical grade materials is essential. If proper grade materials are not used, infection risks skyrocket, and at a minimum, various inflammatory responses can be expected. Implantation of irresponsible materials should not even be considered.

Neuticles and products like them are sold through medical and veterinary suppliers, and are not usually available to the general public (and might even be illegal in some areas). There is of course the option of approaching them as a "high school science teacher" or an "artist", but ultimately such a path is probably illegal and could lead to secondary problems.

Beads suitable for implantation, including larger beads, are available through most body jewelry manufacturers (just ask them for polished undrilled beads in your desired size and material). They can also be obtained from industrial suppliers at a much lower cost, but they'd need to properly finished before use.

Finally, I should noted that medical grade materials, especially in larger items (beads larger than 3/4" in diameter for example) can get VERY expensive. They're expensive for a reason, and if one skimps on materials, odds are it will be regretted later. If your supplier, doctor, or artist can not tell you EXACTLY what is being put in you, you're not dealing with reputable people.

Generally a doctor does this procedure as it is quite invasive and carries a considerable degree of risk. Contamination of the inside of the scrotum can lead to a fast-spreading and life-threatening procedure. Assuming that sterility requirements can be met, on a technical level, the procedure is no more difficult than many of the implant procedures attempted by amateur practitioner (who can be contacted through the obvious underground channels).

It is strongly urged that you seek the assistance of a trained and qualified medical professional for procedures such as this. Yes, it will cost more, and yes, it will mean having to answer more personal questions, but ask yourself: "How much is my life worth to me?"

Laws will vary from region to region, but realistically one must be an accredited medical doctor to legally perform such a procedure.

Beading, also known as pearling (after the Yakuza -- Japanese Mafia -- practice of implanting pearls under the shaft skin of the penis while in prison), is the implantation of small beads and other small objects under the skin. Most often beading is done on the penis, but it can be done anywhere on the body. Genitally, these are done primarily for the purpose of physical stimulation (for both the wearer and their partner), as well as everywhere for aesthetic reasons.

Most simple implants are made of small inert metal beads (stainless steel, titanium, and niobium), as well as various plastic beads (nylon, teflon, silicone, etc.). It is important that the material be biocompatible to minimize risks.

Generally the beads are 3/16" or larger (smaller beads probably won't be that noticeable for most people), with 1/4" probably being the most commonly sized bead. Small rods ("ribs") are sometimes used as well, generally in 8ga or 6ga. Bead sizing is largely determined by personal preference.

While some artists choose to implant them using a procedure similar to the "3D-Art" procedures (described below), most use a procedure almost identical to piercing. A typical procedure might go as follows:

1. Bead location is marked, with an entrance and exit point on each side. These entrance and exit marks are far enough away from the bead location that the bead won't put direct pressure on these wounds (which could easily lead to rejection).
2. These marks are then clamped, and pierced (generally with an 8ga or 6ga needle; some practioners prefer to pierce using a scalpel).
3. The needle is followed through by a taper (generally a special multi-part taper designed to make beading easier) which increases the size of the holes. The clamp is removed.
4. Following the taper, a bead is held between the taper and a "pusher rod" to place the bead into its final location. The taper and pusher are removed, leaving only the bead in place.
5. The openings are closed using suture tape, or in some cases actual sutures.

Assuming the bead was placed properly, is of a high quality material, and proper attention was paid to sterility concerns, healing a beading should be relatively uneventful and trouble-free. Other than regular washing, no aftercare should be required (if sutures were used, they can be taken out at home about a week later using cuticle scissors and tweezers).

In the rare case that beadings become infected, a doctor will probably prescribe antibiotics. Because there is no real way for these modifications to drain, in the case of infection you may be required to have the implants removed.

Finally, during the first few weeks of beading, it is essential that no stress be put on the beads. If you do, you could induce rejection by opening the placement holes, as well as causing shifting.

With proper placement and initial aftercare, beadings should not reject. If they do start rejecting, there's not much you can do about it other than take them out.

Implants of all kinds, including beading, often move slightly from the position they are first placed in. The initial placement, the person's anatomy, and the diligence of their aftercare all determine the amount of shifting.

In general, there are three phases of shifting. Some shifting will happen immediately due to the shape of the anatomy surrounding the beading. The bead will naturally shift slightly to sit in any divots or low spots -- this is difficult to minimize but can be to some extent controlled with the aid of a pressure bandage (as well as sensible placement). Secondary shifting may happen if the beading is abused during the healing phase (ie. if you have sex with fresh genital beads, don't be surprised when they all clump up in the loosest part of the skin). Finally, especially in men with loose shaft skin, the site-specific adhesion of the beads may be minimal enough for some shifting to continue indefinitely.

There is minor risk of tissue resporption and damage to surrounding tissues, but in general, these types of implants are small enough and placed in loose enough skin that these risks are minimal. That said, beading in non-genital skin (for example, beading on the sternum) can have quite dramatic tissue resorption issues (more information is given below in the "3D-Art" section).

As with genital piercings, some people swear it's the elixer of youth, and some people can't even tell they have them. For other people (generally the partners, not those wearing the beads), the sensation of a beaded penis is unpleasant. Either way, it is extremely subjective.

Creative placement of some beads inside a condom is a more sensible solution, at least as a "test run" for most couples.

Some cosmetic plastic surgeons in the West offer this service, as well as many Asian practitioners. Additionally, many body piercers around the world offer this procedure -- using the method mentioned above, there is no reason why any competent body piercer shouldn't be able to perform a simple beading procedure. Of course, many may choose not to for reasons including ethical and legal concerns. Ask around at piercing shops in your area to find artists willing to do beading.

Most people agree that this procedure falls inside what a person who is competent in piercing themselves should be able to achieve. Obviously only you know the answer to that. If you have ANY doubts, seek the assistance of a professional.

This of course varies from region to region, but in general similar laws apply to small-scale beading as apply to genital piercing.

"3D-Art implants" (a term coined by Steve Haworth, one of the first modern proponents of this artform) are objects implanted fully under the skin, generally for the purpose of affecting a sculptural change of the surface topography.

For smaller implants, some artists use a procedure similar to the beading procedure above, but this is not the norm, nor is it even an option for anything much larger than a small bead. The majority are inserted using a surgical method, roughly simplified as:

1. The final location of the implant is drawn on the skin as a reference.
2. An incision is made a small distance away from where the implant will rest.
3. Through this incision, a "pocket" is formed using dermal elevators.
4. The implant is inserted into this pocket.
5. The incision is closed using sutures or suture tape.

A dermal elevator is a small "spatula" used to separate layers of tissue. Different spatula designs of varying shapes and sharpnesses are used depending on the area. A scalpel is not acceptable for creating a pocket, as it can not easily be stopped from cutting through the skin layers rather than simply separating them. As well as elevators specially designed for the task, practitioners may use other techniques such as inserting surgical scissors or hemostats into the pocket, and then opening them to widen it.

Assuming that there is no reaction to the material, placement is responsible, and proper care was paid to a sterile procedure, implant healing should be relatively trouble-free. The best thing you as an individual can do to ensure good healing on an implant (and this applies to all body modifications) is to be in good health and have a strong immune system. This means be rested, eat well, and don't smoke.

Yes, in rare cases (usually with either poor initial placement, overly large implants, or implants with vertical points) implants may reject up through the skin. This is very unusual, but when it happens it is almost always irreversible and results in the loss of the implant, as well as sometime significant scarring, both internally and externally.

The only visible scarring should be from the incision that was used to place the implant under the skin. This implant does not need to be placed immediately next to the implant and can often be located in a discrete location away from the implant itself. For example, doctors sometimes insert breast implants via an incision in the navel or the armpit. Forehead implants may be placed using an incision just inside the hairline.

Other than incision placement, incisions should be made with the grain of the skin, and should be treated gently during healing. In addition, proper suturing plays a dramatic role in the amount (and type) of scarring. An experienced practitioner should find suturing no more difficult than tying their shoes.

Implants can be stretched just like piercings. Many of the horn implants (for example, the Engima's well-known horns) start out as smaller implants and are upsided through multiple procedures. If particularly tall (that is, implants that stick out from the skin a great deal in relation to their footprint) implants are desired, using multiple steps like this can greatly reduce the irritation to the skin over the implant, and minimizes chances of rejection. That said, most larger implants are inserted in a single step.

The risks are significant, and sadly, almost always overlooked. For a complete index of implant risks, please visit BME/Risks at:
http://www.bmezine.com/risks/

A few of the more serious risks include infection, tissue resorption, implant surface contamination, biocompatibility risks, shifting, pressure on nerve and muscle, as well as risks related to the procedure itself (anesthetic allergies, the "mod before client" phenomena, etc.).

Infections in implants must be taken very seriously. When an infection occurs in an open wound like a piercing, dead tissue, bacteria, and other undesirables can be easily flushed out without the need for more aggressive treatment. Implants on the other hand are a closed wound, and as such any waste produced when fighting an infection must be reabsorbed by the body. Often this is not a viable task, and an infection of this type can quickly spiral out of control. If you value the body part that has been implanted (and your life), it is essential that immediate medical care be sought in the case of implant infections.

I'm sure everyone knows how water dropping on a stone eventually digs a hole into it. Water is a lot softer than an implant, and your body is a lot softer than stone. As a result, over time, implants will slowly eat away at the tissue beneath them -- a better known example of tissue resorption is gum recession from labret piercings.

Resorption will happen with all materials, but is minimised with soft materials such as silicone. In addition, the rate at which it happens varies from person to person -- some people will get very little even from harder implants, but, unfortunately it's not as if you can take a test for your resorption potential. Also, because the implant is under your skin, you may not even become aware of this problem until it's too late if it's not in an area that causes functional problems -- symptoms can take literally decades to show (although it is not unheard of for them to start showing within a month).

When an implant is placed on top of muscle, nerves, or blood vessels, it has the potential to interfere with their functioning. For example, I recently met a person with a pair of star shaped implants half way up the inside of each forearm. Shortly afterwards, each star began sinking into the tissue below and can now barely be felt -- although they are visible due to the regular fluid retention and bruising. In addition this person is suffering from radiating pain and cold chills in the area (a condition I've observed frighteningly regularly). Naturally, this person is now seeking medical assistance in their removal.

Usually these problems become apparent shortly after the procedure is done, but when the complication is nerve related, it's very possible for symptoms to be apparent to the client during the procedure itself as the tools stimulate the nerves. If you notice this happening, be sure to tell your practitioner so they can assess the risk, and either abort or modify the procedure for your safety.

It should also be noted that these problems are not necessarily reversible so it is important to stop them immediately. The easiest way to make sure this isn't an issue is by not placing implants on top of muscular tissue, as well as tendons, ligaments, nerves, and other bits of your body that are in your best interest to preserve the functionality of.

Carved silicone implants often have a remarkable rough surface, which can contain many small cuts, barbs, and pits. While the texture of the surface will irritate the body and measurably increase complications, overall the body is able to encapsulate these with scar tissue and there's no reason why a healthy person can't heal them. However, a surface with such a texture becomes contaminated far more easily, and because of the nature of these textures, any contamination may survive autoclaving, especially if cleaning is inadequate.

For example, a rough surface that is being worked on in a studio environment could easily become biologically contaminated. Environmental factors such as paint dust or even pollen can easily contaminate the implant, and, if released as the implant moves under the skin, may cause problems even long after the implant has been removed.

After implantation, many implants shift slightly according to the pocket that has been made for them, as well as the local anatomy (the implant may tend to shift to a "sweet spot"). A pressure bandage holding them implant in place may help for the first few days (once surrounding tissue has fibrosed down again, subsequent shifting should be minimal), as well as taking care not to sleep on the implant. Advanced practitioners (ie. doctors) may use alternate materials (for example, implants with a foam surface which "glues" it to surrounding tissue via in-growth), as well as techniques such as suturing the implant to surrounding tissue.

In any case, clients should be prepared to accept some level of migration. In general, shifting the implant after it is healed is not an option (removal and subsequent re-placement is).

Many practitioners are very excited when asked to do interesting implant work, and sometimes allow this excitement to allow them to overlook more important concerns such as the viability of the procedure or the safety of the client. If you approach a practitioner and you are unstable, overly young, or otherwise unprepared for the long-term and short-term effects of the procedure, or cannot grasp its permanent, a responsible practitioner should -- and must -- turn you down. In addition, if you approach a practitioner and ask for a procedure that is not safe, they should not -- and must not -- perform this procedure, no matter how much you beg them.

Sadly, this is usually not what happens. Understand that if the person you are approaching is not a licensed doctor, they are probably working illegally, and are certainly not subject to any sort of professional review or monitoring. That doesn't mean that there aren't many talented people working outside of the medical sphere, but it does mean that clients must be especially vigilant if they care about their own safety.

On top of the obvious risks associated with invasive surgical procedures, assuming that anesthesia is used, it can carry significant risks as well, including anesthetic allergies, toxic overdoses, adrenaline excitement, and similar problems. If the practitioner is using this anesthetic illegal or in a non-medical environment, it is likely that they will not have sufficient support to handle these complications, putting your life at serious risk.

Any biocompatible material can in theory be used for implants including metals (implant grade stainless steels and related alloys, titanium and titatnium alloys, and even high karat gold) along with various synthetic materials (nylons, silicones, teflon, etc.). Organic materials as well as many polymers than break down under the hard conditions of the body should be absolutely avoided.

Doctors have access to many advanced materials offering a multitude of options, but the few I've listed above are what non-medical practioners are limited to. This is in part because many medical grade implants are restricted to sale and use by doctors only, but also because there is no reasonable way for a non-medical practitioner to achieve sufficient training to safely use these materials.

If you are interested in using foams and similar implants you must seek the assistance of a cosmetic plastic surgeon.

Everyone has seen the news reports claiming that the Enigma's horns are coral. It's an interesting idea, but they are not, nor are any of the other ones that are out there. In theory coral and other similar lattices may be used as an implant material, with the purpose of biological assimilation.

The general theory is that your body will grow into and replace this implant, essentially making the implant not only permanent, but making it a living part of your body. It is important to note that this type of implant science is quite advanced and not only is it inappropriate for non-medical practitioners to attempt it on the public, but only a small number of doctors have experience with it.

This should be filed in the "future" folder for now.

First of all, medical politics are changing and one should never discount the option of having these procedures done by a qualified, trained, and government sanctioned cosmetic plastic surgeon. These are all advanced procedures that are done a disservice when done without such training. It will cost more to use a doctor -- quite possibly a LOT more -- and it can take a lot of asking around to find a doctor even willing to take you seriously, but given the choice it is clearly the best option.

That said, if you have read the above, understand the risks, and are willing to take them, ultimately it should be your right to make decisions about your own body. A small number of body piercers (and ex-body piercers) along with other underground practitioners operating on varying levels of publicity are offering these procedures. Naturally it is essential to ask to see a portfolio, as well as asking for referrals, but understand, as I have mentioned above, that as soon as you leave the regulation of the medical industry, that many, many wildcards and unknowns come into play.

This of course varies from state to state, but overall, offering such services to the general public (rather than just close associates) as a non-medical practitioner is a very gray area, if not a clearly illegal act. In addition, even if performing the procedure is legal, related issues (injecting anesthesia, possession and use of implant materials, etc.) are probably not legal.

If the surface of the implant is smooth and non-porus, and the implant is of a fairly simple shape, removal is not generally any more difficult than implantation. However, if the implant becomes "attached" to the body via either surface in-growth or simple mechanical adhesion due to the shape of the implant, removal can become very complicated and difficult.

It should also be noted that if an implant is being removed due to complications that have arisen, that these complications may continue after the removal of the implant. Do not get an implant unless you thoroughly understand the risks and are willing to accept the full potential consequences of such a procedure.

Transdermal (percutaneous) implants are implants that pass through the skin, with one part of themselves permanently under the skin, and the other part above the skin. An obvious example of these technique is the "metal mohawk" which has received so much television coverage.

Transdermal implants, as done by the body modification community, straddle the line between piercing and implant. While they do integrate into the body somwhat, overall they heal more like a surface piercing (with a fistula forming around the implant, rather than the body just sealing the implant at the point where it passes through the skin).

Yes, there are transdermal implants (various ports being an obvious example) done by the medical community which integrate very thoroughly with the body. However, these generally do not achieve an aesthetic that is electively sought out, nor are they even available on an elective basis. When transdermal implants are discussed in the context of the body modification community, it is referring to the more "piercing-esque" concept.

In most cases, the procedure goes like this:

1. The location where the transdermal passes through the skin is marked, as well as an incision point (usually an inch or two away).
2. The incision is opened with a scalpel and a dermal elevator (often a septum elevator) is used to create a pocket to slide in the implant).
3. Using a dermal punch or scalpel, and using the elevator as a backing (so underlying tissue isn't damaged), the hole that the implant will pass through is made.
4. Through the first incision, the base of the transdermal is slid in, until its post passes through the hole. If the implant is two-parts, the top half is screwed on.
5. The initial incision is closed with sutures or suture tape.

A transdermal looks a bit like a labret, but with a much larger backing. This backing is often has large holes drilled through it -- tissue grows through these holes to help secure the implant (imagine a figure 8, with the post in the center). Using just a labret stud will not usually work.

Overall transdermal implants carry the same set of risks as surface piercing or pocketing, with the primary risk being rejection.

Transdermal implants performed by the medical industry (for example for percutaneous energy transmission systems) have quite different risks and complications. These implants work with the aim of "bonding" the skin to the implant, and use specialized materials such as porus titanium.

There are only a very small handful of practitioners offering transdermal implants, primarily because not only is it a specialized procedure, but also because manufacturing proper transdermal implants is beyond the capabilities of the average piercing studio.

This will of course vary from place to place, but it's hard to say exactly how courts would interpret transdermals. While the end effect is not that different from a piercing, the procedure itself is radically more complex. Whatever the legal interpretation of transdermals are, it is safe to assume that related issues such as the illegal use of anesthetics could pose problems for non-medical practitioners.

Silicone injections are exactly what they sound like -- injections of liquid silicone into the body. In this context, this most often is injections in the male genitals, with bulking up achieved over multiple sessions.

The potential changes are, for lack of a better word, "monstrous". As far as male genital injections, circumference increases of as much as three hundred percent are definitely not unheard of. Done slowly, the level of sculpting that can be achieved is almost limitless.

In general this procedure is not reversible, at least without extensive invasive and damaging surgery.

Done properly, silicone injections are done using a special syringe and feeder system that allows the silicone to be injected into the tissue at a consistent rate. That said, many unscrupulous practitioners use far more primitive methods -- often with disastrous results.

There are many experienced proponents of silicone that swear by its safety when used responsibly. However, perhaps in part because of the bulk of untrained estheticians that injured customers, the FDA warns that they have not approved "the marketing of liquid silicone for injection for any cosmetic purpose, including the treatment of facial defects or wrinkles, or enlarging the breasts. The adverse effects of liquid silicone injections have included movement of the silicone to other parts of the body, inflammation and discoloration of surrounding tissues, and the formation of granulomas (nodules of granulated, inflamed tissue)."

Silicone has been injected successfully in most parts of the body, including the penile shaft (under the skin, not in the caverosum or the glans), the scrotum (but not in the testicles), legs, chest, arms, eyebrows, and so on. In theory a skilled doctor could resculpt an area with enough talent and forethought. It is essential that the practitioner be well trained and experienced.

The medical associations governing the actions of most western doctors do not recognize silicone enhancement. As such they can neither advertise nor perform these services. Most silicone injection is either performed under the table, by non-doctors, or in countries with more permissive medical laws (for example Mexico or Brazil).

That said, there are many unlicensed doctors who can be found by asking around at various esthetics salons in ethnic communities (often immigrant doctors find it difficult due to prejudicial local laws to get their licenses and are forced to work in the underground plastic surgery market). In addition, there are communities of men, especially in the gay community, who are "extreme cock" silicone advocates who are able to provide referrals to such services.

Even though chemically a high-grade industrial silicone is not that different from a medical grade silicone, it is not manufactured with the same precision, and is utterly unacceptable for injection. If improper silicone is used, massive scarring and complications may occur, requiring extremely unpleasant surgery to even partially correct.

No. Even if you could illegally import medical grade silicone, it would be very difficult to inject properly.

Saline injections are temporary and offer little to no permanent changes.

While mineral oil injections often offer permanent results, these results come with horrendous scarring and disfigurement, usually requiring extensive surgery to correct. Under no circumstances should mineral oil be considered as an acceptable substitute.

These materials are accepted by the medical community and you can approach the medical community for them. That said, the body does reabsorb them over time, so if you're looking for permanent or "freaky big" changes, these probably won't do what you're looking for.

In most countries, silicone injection is not legal for doctors to perform, let alone non-medical practitioners. In addition, use and/or possession of the related materials and tools may not be legal either.