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I was disappointed to hear my uro say my sack appears too small for the AMS pump. He said my options appear to be AMS 2-piece or Titon. Don't want former for fuller flaccid state. Really want AMS 700 LGX. Anyone else dealt with this issue?

Whatever you do, don't get a 2 piece

Just get a Titan then.

I've looked at several pumps and have the LGX MS ( momentary squeeze) pump. I cannot imagine that small of a pump not fitting in any nut sack. The scrotum is flexible. Sounds like a doc who wants to go a quick easy route or no experience to me. My balls have atrophied a lot over the years with the trt but the pump still is not as big as my nuts were before. Only slightly bigger than the poor shrunken rt nut it attacks all the time. It is not a huge pump. Do not go with a 2 piece. Too many doctors said they do no last as long and the reservoir is in the pump so it is not small. Cylinders ARE small as the pump reservoir cannot holed enough for big cylinders. Ask another doctor. Best as I remember, Coloplast and AMS pumps are advertised to be smaller size than years previous. If you can find the time line someone posted about implant history, it should describe the changes to the smaller pump profile.

When Dr Perito did my revision (two years ago this month) he said everything in me was too big..... He put in a "smaller Titan" and a smaller pump and release mechanism..that part I could tell was smaller. My dick is about the same size as my first (larger) implant. Before RP, I was never "big"..... 6".....now 5.5"....very happy....

I really don't have any experience comparing the size of my scrotum to the scrotums of other guys. But Dr Kramer made an offhand remark after my surgery that I had a small scrotum. That being said I have had no problem accommodating an AMS pump down there. My guess is that if you consult with an experienced high volume implant surgeon like Dr Kramer, he will find a way to give you what you want.

TerryH I thing you should at,least get a second opinion. Also agree with Merrix (as usual) there is little downside to a Titan. It is what Dr. Khera felt was best for me and we are very happy with it.
Cincinnatus

I do not have a large hanging scrotum and because I am high and tight couldn't imagine squeezing anything else in there. I have the AMS MS pump with the CX implant and it fit in and they all get along fine. Get a high volume surgeon second or third opinion. Especially before getting anything other than 3 piece in this day and age unless you can't operate 3 piece due to hand issues. Sounds odd to me.

I have a good size sack but pain and cold make it shrink to 1/3 of its size.
After the surgery, after everything down there went back to normal I noticed that my pump is in front and can be seen especially if i'm lying on my back.
When I asked the doctor about it he said because I have a small sack.
No matter how small your sack is, the pump should fit. But I think your doctor is afraid to do it.

SEARCH FOR ANOTHER SURGEON AND DO NOT PUT THE 2-PIECE IN THERE.

Regardless if the doctor wants the "easy way" or whatever, Getting a 2nd and 3rd opinion is needed now, because you have doubts that need to be clarified before you choose elective surgery and you need a tiebreaker decision. If you don't then if the surgery is less than expectations, you will blame yourself. You don't want significant doubt when you go into surgery. I'm a pretty calm fellow and was thinking afterwards WTF DID I DO, heheheheh. Buen suerte