XVII Harry Benjamin International Gender Dysphoria Association Symposium
31 October - 4 November 2001, Galveston, Texas, U.S.A.

Management of a ‘Siliconoma’ in a Transsexual Subject

TOORIANS, A.W.F.T. The Netherlands
Co-authors: R.I.F. van der Waal, M.R. van der Scheur & L.J.G. Gooren (The Netherlands)

Silicone is used in implanted prosthesis, but is also injected as a substance subcutaneously and intradermally to improve wrinkles and scars or to feminize body contours of male-to-female transsexuals. Silicone has for a long time been thought of as an ideal inert material but its clinical application is, however, not without complications. It is not clear whether this is due to the injected silicones themselves, or to impurities of the injected material or to the injection technique. We have seen in our clinic several cases who had had silicone injections to broaden hip contours and who, years later, had an accumulation of the silicone sunk from the hips to the area around the ankles leading to severe inflammatory reactions and ulcers. One of these cases was analyzed in detail. This person was admitted three times with fever and complaints of local redness, swelling and pain in the lower legs. MRI imaging showed thickening and infiltration of subcutaneous tissues. Ultrasound showed signs of cellulitis. Histological examination of excision material revealed: multiple round or oval shaped optic empty spaces very likely filled with silicone material. There were few granuloma formations but the histological diagnosis was compatible with siliconoma in view of the previous silicone injections. The patient was initially treated with high dose oral corticosteroids. But in view of the long-term side effects, other forms of immune-modulating therapy were considered. Clofazimine, a safe anti-leprosy drug with immune-modulating properties, was administered instead, with good results. Red skin discoloration occurred after some weeks, which is a well-known side effect of clofazimine. This was unacceptable to the patient and subsequently treatment was shifted to salazopyrine, another immunomodulating drug with, however, more potential side effects. This regimen had also beneficial effects. Unfortunately, the patient was lost for long-term follow-up.

This case report demonstrates that both clofazimine and salazopyrine are alternatives to corticosteroids in the management of chronic tissue reaction to injected silicones. In view of the frequent and bothersome irreparable side effects, injection of free silicone must be discouraged.