What is the procedure for Nexplanon (etonogestrel implant) removal?

Nexplanon Removal Procedure

The removal of Nexplanon (etonogestrel implant) should be performed by a trained healthcare professional through a small 2-3 mm incision using ring forceps, with the procedure typically taking less than 5 minutes when performed by experienced clinicians. 1, 2

Pre-Removal Preparation

• Before removal, the implant should be located and palpated in the arm to confirm its position 1
• No specific examinations or tests are needed before removal of an implant in healthy women 3
• The procedure should not be performed in the presence of active infection at the removal site 3

Removal Procedure Steps

• The implant is typically removed from the inside of the non-dominant upper arm, 6-8 cm above the elbow 3
• Standard removal technique includes:
  • Locating and marking the distal end of the implant 2
  • Cleansing the removal site with antiseptic solution 1
  • Administering local anesthesia beneath the distal end of the implant 2
  • Making a small 2-3 mm incision at the distal tip of the implant 2
  • Using ring forceps to grasp and remove the implant through the incision 2
  • Closing the incision with adhesive skin closures if needed 1

Special Considerations

• For non-palpable implants:

  • Ultrasound or X-ray imaging may be required to locate the implant before removal 4
  • Nexplanon contains barium sulfate, making it visible on radiography 3
  • Real-time fluoroscopic-guided localization can be used for radiopaque Nexplanon that cannot be palpated 4
  • Referral to specialists may be necessary for deeply inserted implants (>5 mm depth) 2

• Potential complications during removal:

  • The most common challenge is encasement of the implant within fibrotic tissue (4.4% of cases) 1, 5
  • Transient nerve injury is rare but possible 3
  • Pins and needles/numbness in the arm/hand/fingers may occur 1

Post-Removal Considerations

• Women will experience rapid return to fertility once the implant is removed 6
• If continuing contraception is desired, a new implant can be inserted immediately through the same incision used for removal 3
• When switching to another contraceptive method after removal:
  • If switching to hormonal methods, they can be started immediately 3
  • If switching to an IUD, it can be inserted immediately 3
  • If no new contraceptive method is started immediately, advise on alternative contraception if needed 3

Timing of Removal

• The implant should be removed by the end of the third year of use 6
• Removal can be performed at any time during the menstrual cycle 3
• For women who wish to continue using Nexplanon, a new implant can be inserted immediately after removal of the old implant 3

Specialized Removal Situations

• For deep implants (>5 mm):

  • Referral to a specialized center may be necessary 2
  • More extensive procedures may be required, including larger incisions (up to 15 mm) 2
  • Removal under ultrasound guidance may be needed 4

• For migrated implants:

  • The axillary region should be investigated first if an implant cannot be located in its expected position 4
  • Interventional radiology techniques may be required for removal of migrated implants 4