Nonpalpable implant removals at centre of experience in France: a cohort study

Abstract

Objective(s): Management and localisation strategies to remove nonpalpable contraceptive implants may be difficult. We aimed to evaluate our imaging modalities to identify deep implant and patient outcomes related to removal.

Study design

In this retrospective study, we reviewed all cases referred to our specialised centre for nonpalpable contraceptive implants from January 2018 to August 2022.

Results

Out of the cohort studied, 47 female subjects exhibited nonpalpable implants. The implant was nonpalpable for thirty-six patients (76,6%) immediately after the insertion whereas it was not palpable several months after the insertion for eleven patients (23.4%). Twelve patients (25.5%) had one or more failed removal attempts before referral.

All 47 implants were successfully visualised via ultrasound in the upper arm: 40 implants (85.1%) were located in the subdermal tissue, 4 (8.5%) were intrafascial and 3 (6.4%) were intramuscular. Depth of the implant was 4.0 mm [1.7 − 12.0]. No clinical factors were statistically associated with differences in depth or location (subdermal vs subfascial). Removal procedures were mainly under local anaesthesia in 74.5% of cases in an outpatient setting. There were two Clavien-Dindo grade 1 complications (one case of cutaneous scar dehiscence and one transient postoperative neuropathic complaint in the upper arm resolved within 3 months under analgetics)

Conclusions

Identification of deep implants requires following the ultrasound modality protocol. Ultrasound detection makes easy and safe implant removal. Training programs for the insertion as well as for the removal of correct and incorrect inserted implants should be continued and developed all around the world.

Keywords:

• Nexplanon® removal
• etonogestrel implant
• localisation
• ultrasound
• contraceptive implant

ClinicalTrials.gov identifier

NCT05932537

Disclosure statement

G. Chene has served as consultants and members of advisory boards for Organon. The other authors (P. Akl, A. Gjorgjievska-Delov, E. Cerruto, S. Morret, E. Nohuz) declare no conflict of interest to disclose.

Data availability statement

Data are available upon reasonable request.