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
facilities.
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.
