XVI Harry Benjamin International Gender Dysphoria Association Symposium
17 - 21 August 1999, London

Reflections on "Transsexualism and Sex Reassignment" 1969 -1999

Rupture of Silicone Gel-Filled Testicular Prosthesis: Causes, Diagnostic Modalities, and Treatment of a Rare Event

Hage JJ, Karim RB, Taets van Amerongen AHM* and van Diest PJ#

Departments of Plastic and Reconstructive Surgery, Radiology*, and Pathology#, Academisch Ziekenhuis Vrije Universiteit, Amsterdam, The Netherlands.

Rupture of the envelope of silicone gel-filled testicular prostheses is a rare event alleged to be unlikely without intraoperative needle puncture. We observed that it may be caused by chronically intermittent trauma or a single acute increase of pressure and report diagnostic and therapeutic modalities.

Four cases that were treated by us over the past 10 years are presented. One of them had testicular implants for Klinefelter syndrome, whereas the other three had been treated for female-to-male transsexualism. Diagnosis was confirmed by ultrasonography and magnetic resonance imaging (MRI). The fibrous capsule surrounding the ruptured prosthesis was left intact to allow for ‘en bloc’ surgical extirpation. Histological evaluation of the resected specimen was performed. Rupture of silicone gel-filled testicular implants may be caused by acute or chronic pressure without intraoperative needle puncture. MRI offers superior diagnostic accuracy and should be regarded the ‘gold standard’ in the evaluation of implant rupture. Ultrasonography is an acceptable alternative. In cases where gross symptoms of scrotal inflammation are lacking, replacement of implants is facilitated by the fibrous capsule that forms around any prosthesis. Transcapsular migration of silicone particles was observed even where fibrous capsule was intact.