Testicular Implant Complications after Transmasculine Gender Affirming Surgery

Purpose: Complications from testicular implantation in transgender men can cause significant distress, repeat visits to the emergency department, and require reoperation for explantation. Outcomes for these implants have not been well described in the literature. This study compares patient and surgery specific factors with complications from testicular implants in transgender men. Materials and Methods: We performed a retrospective review of patients who underwent testicular implantation. Surgery was standardized across patients with placement through incisions at the top of the labia majora or medially during metoidioplasty. Complication rates, including infection, erosion, migration, and pain requiring removal was compared with patient factors, including body mass index (BMI), smoking status, and implant size. Results: Of the 116 testicular implants, 12% had a complication requiring removal. The most common reason for removal was erosion of the prosthesis, which occurred in 6 instances. Migration was a relatively frequent complaint, with 10% of patients noting relocation of an implant. However, only 4 implants ultimately underwent reoperation for migration. Four implants caused enough pain to require reoperation. On logistic regression of BMI, age, smoking status, and immunocompromised state on removal of prosthesis, no factor was found to be a significant predictor of removal. Increasing implant size was not associated with an increased likelihood of removal. Conclusions: Complications after testicular implants in transgender men are not uncommon events. Although there appears to be a growing trend toward smaller prostheses in the literature, our data suggest that implant size is not a significant predictor of complications requiring prosthetic removal.