Implanon insertion and removal :
– Etonogestrel implant (Implanon) is a single-rod progestin contraceptive placed subdermally in the inner upper arm for long-acting reversible contraception (3 yr).
– The implant may migrate a short distance (<2 cm) over time.
– Women who are postabortion or postpartum (even if breastfeeding) can have the implant inserted immediately after termination of pregnancy or delivery.
– Unscheduled bleeding is the most common side effect & reason for discontinuation.
– Back-up contraception for 7 days after insertion is important if inserted away from the LMP.
– The hormonal effects end promptly after removal and >90% of women ovulate within 3-4 wk of removal.
– If the implant is not removed after 3 yr, the contraceptive effects persist, possibly for as long as 2 years more.
– Rods too deeply placed can’t be palpated under the skin, but can be seen with imaging studies (Implanon can be identified with high resolution U/S or MRI; Nexplanon is radio-opaque and can be identified with just plain X-ray).
– Such “lost” rods should be located with a high frequency (10-15 mega Hz), short focus, linear U/S transducer prior to attempting the removal. Our target here is to identify an acoustic shadow (the rod itself is more difficult to see), measure the depth & draw a line representing the rod location on the surface of the skin. If the rod is very deep (>1.5-2 cm), U/S should be used during the removal procedure because movement of the patient’s arm may change the location of skin marks in relation to the underlying implant.
– Removal of contraceptive implants is never an emergency; there is no evidence that their presence adversely affects pregnancies or other conditions.
– Finally, I will upload videos for Implanon insertion removal later. After sonographic localization of the implant, make a 3 mm incision transversely above the implant, open the modified vasectomy forceps over the implant, close the forceps around the implant, and then use the forceps to remove the implan.
Missed Implanon PPT( power point presentations):