Removal techniques for deep sub-dermal, sub-fascial & intramuscular Implanon contraceptive implants: Experience of a Fertility Control Unit

Removal techniques for deep sub-dermal, sub-fascial & intramuscular

Implanon contraceptive implants: Experience of a Fertility Control Unit

B.A. Gbolade, M.J. Weston

Fertility Control Unit & Radiology Dept., St. James’s University

Hospital, Leeds, UK

Introduction: Implanon was launched in the United Kingdom in September

1999. Since then, thousands of women have used the implants, providing the women,

their carers, and the manufacturers a wealth of post-marketing experience of the

use of the contraceptive. It is difficult to know the exact number of women who

have used and are continuing to use Implanon, which has led to a call for a

monitoring scheme. Ease of use appears to be the most common reason for choosing

Implanon and one of the best-liked features while bleeding irregularities appear

to be the most commonly reported side-effect, followed by weight gain, moods and

headaches. The UK is the only country where theoretical training is followed by

live training, a significant factor in reducing complication rates. However,

cases of poor insertions still occur, leading to very difficult removals of

deeply inserted implants. Guidelines have been published for locating such

implants but guidelines about removal procedures and techniques are very

difficult to come by and are dependent on operator experience and available


Aims and Methods: To report on our experience of and describe our

techniques of accurately locating and removing deeply removing deeply placed

Implanon contraceptive implants over a period of 4 years. To also identify

factors that may identify deeply placed implants that are likely to be

successfully removed under local anaesthesia and those more likely to require

removal under general anaesthesia.

Results: To-date, we have attempted removal of 15 deeply placed

Implanon contraceptive implants, all referred from outside our unit. Some were

placed deep into the fat layer; some just below the muscle fascia while others

were placed in the biceps muscle. The location of the implants ranged fro 3 to

6mm below the skin surface. Previous attempts at removal ranged from 0 to 3. One

patient had attempted self-removal using a screwdriver and a pair of scissors.

Implants that were located above the muscle fascia were more likely to be

removed successfully under ultrasound guidance that those located below the

muscle fascia. Thos located intramuscularly were more likely to require general

anaesthesia and intraoperative ultrasound guidance. We illustrate our techniques

of removing these Implants.

Conclusions: Despite concerted efforts to ensure accurate insertion of

Implanon contraceptive implants, cases of deeply placed implants still occur. On

occasions, removals of these implants require general anaesthetic. We have

identified factors that may predict such cases and descried techniques for

removal of such implants. Patients with deep implants should be referred to

centres with experience of dealing successfully with such cases.

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