What should I do if my contraceptive implant cannot be felt?

Do not attempt removal at the GP practice. Imaging is required first — X-ray and ultrasound — to locate the implant precisely before any intervention. Contact a specialist gynaecological surgeon for a pre-operative consultation.

Why can a contraceptive implant migrate deeper into the arm?

The implant is normally placed just under the skin, on the inner side of the upper arm. Several factors can lead to deeper migration: insertion that was too deep at the outset, thin subcutaneous tissue, intense physical activity (particularly weight training), or a fibrous reaction around the implant (encystment). It can then migrate into the muscular fascia, sometimes near neurovascular structures.

Is the removal of a deep contraceptive implant painful?

No. The procedure is performed under effective local anaesthesia: the area is fully numbed before any incision. During the operation, the patient feels no pain — only slight pressure at times. Afterwards, simple painkillers such as paracetamol are usually sufficient for 24 to 48 hours. Normal daily activities can resume the next day, with a few precautions (avoid weight training and heavy lifting for one week).

How long does recovery take after implant removal surgery?

Recovery is generally straightforward. Most patients return to a sedentary job within 3 to 7 days. Avoid heavy lifting for one week. Light sport can be resumed after 2 to 3 weeks.

Contraceptive Implant Removal: Deep or Non-Palpable

Q: Where can I get a contraceptive implant removed in Paris?

A palpable contraceptive implant is removed at the practice under local anaesthetic in a few minutes. When the implant is deep, non-palpable, or a previous removal has failed, it must be removed in the operating room after ultrasound location, under local anaesthetic. Dr Zeitoun, a gynaecological surgeon in Paris 8th and Neuilly-sur-Seine, handles both straightforward and complex contraceptive implant removals.

Q: Is surgical removal of a deep implant dangerous?

In the vast majority of cases, the implant is accessible to an experienced gynaecological surgeon and removal is safe. In rare situations — deep intramuscular migration or proximity to vascular structures — collaboration with an orthopaedic or vascular surgeon may be organised. The pre-operative imaging workup ensures your safety.

Q: Is implant removal covered by insurance?

Surgical removal of a deep contraceptive implant is reimbursed by the French health system (Assurance Maladie) on the basis of the standard tariff. Dr Zeitoun practises in Sector 2 — additional fees apply. A detailed quote is provided at the pre-operative consultation. Your complementary health insurance may cover part or all of the additional fees.

Key points · 1 min read

Deep contraceptive implant: key points

Definition. Contraceptive implant lying too deep under the skin and not palpable at clinical examination.
Symptoms. Non-palpable implant, local pain, paraesthesia (tingling), sometimes neuropathy.
Pre-operative work-up. High-frequency ultrasound first. MRI if ultrasound is inconclusive.
Technique. Surgical removal under local or general anaesthesia with pre-operative skin marking.
Hospital stay. Day-case in most situations. Discharge the same day.
Timeline. Surgery can be organised within 1 to 4 weeks depending on imaging availability.

KEY FIGURES

Key figures — Deep contraceptive implant removal

Medical statistics at a glance for quick understanding.

3 years

effectiveness (Nexplanon®)

99.9%

contraceptive effectiveness

< 5%

difficult-to-palpate implants

< 1%

deep migrated implants

5-10 mm

recommended insertion depth

30-60 min

OR removal duration

1-2 cm

US-guided incision

10-15 min

simple office removal

office removal failure rate

100%

OR success with intra-op US

1-3 days

rest period

< 1%

complications

The subcutaneous contraceptive implant (Nexplanon) is inserted in the arm in a few minutes at the GP practice. In some cases, however, it gradually migrates into deeper tissue and becomes impossible to feel — or to remove — by simple means. This situation, which affects approximately 1 to 2% of patients with an implant, requires specialist surgical management.

For full information on the surgical procedure, see our dedicated page on deep implant removal.

How does an implant end up too deep?

The implant should normally sit just below the skin, in the superficial subcutaneous tissue of the inner arm. Several mechanisms can lead to deep migration:

Placement too deep at the time of insertion — the main cause
Spontaneous migration through the connective tissue over time
Progressive fibrosis trapping the implant within a fibrous sheath
Significant weight gain after insertion

Important: in rare cases, migrations towards the thorax (subclavian vessels, lung) have been reported in the literature. This is exceptional, but it is why a full imaging workup is essential before any removal attempt.

Symptoms of a deep implant

Implant no longer palpable at the insertion site
Persistent pain or discomfort in the arm
Previous failed removal attempt at the GP practice
Sensory changes in the arm (tingling, numbness)
Unexpected return of fertility — suggesting the implant has lost its hormonal efficacy

If the implant is no longer palpable, do not attempt removal at the GP practice. Prior imaging is essential.

Pre-operative workup: X-ray and ultrasound

Before any intervention, two investigations are required to precisely locate the implant:

X-ray of the arm (front and side views) — the implant is radio-opaque and visible on plain X-ray. This confirms it is still in the arm and rules out thoracic migration.
Ultrasound — identifies the exact depth of the implant, its relationship to surrounding neurovascular structures (basilic vein, median nerve, brachial vessels), and guides the surgical approach.

These are prescribed at the pre-operative consultation and allow the surgeon to plan the procedure safely.

Who can perform the removal?

Once imaging is available, it is analysed before any decision. In the vast majority of cases, the implant remains accessible to an experienced gynaecological surgeon. In rare situations — deep intramuscular migration, proximity to vascular structures — collaboration with an orthopaedic or vascular surgeon is arranged.

The key risk is injury to the basilic vein, the median nerve, or the brachial vessels during dissection. Only a surgeon trained in fine tissue dissection, in a fully equipped operating theatre, can perform this safely. This pre-operative assessment is precisely what ensures your safety.

The surgical removal procedure

Removal is performed in the operating theatre under local anaesthesia. The patient lies with the arm positioned appropriately. After antiseptic preparation, an incision of approximately 1 to 2 cm is made at the site indicated by ultrasound. Dissection is careful and progressive, respecting the adjacent nerve and vascular structures. The implant is identified, freed from its fibrous sheath if necessary, and extracted. The wound is closed with a few absorbable sutures or steri-strips.

The procedure takes 10 to 20 minutes. The patient goes home the same day. Recovery is straightforward: dressing to be kept for 48 hours, no heavy lifting for one week.

Is your implant not palpable or causing pain?

Dr Zeitoun manages deep implant removals at his Paris 8th practice and at Clinique Hartmann (Neuilly-sur-Seine). Rapid consultation, detailed quote before the procedure.

Book an appointment →

Why a surgeon rather than a GP?

Removal of a superficial implant can be performed by any practitioner trained in insertion. But once the implant is deep — located below the muscular fascia or near neurovascular structures — the situation changes entirely. Only a surgeon trained in fine dissection, in a fully equipped theatre, can perform this safely.

Dr Zeitoun, gynaecological surgeon trained at Institut Gustave Roussy, performs this procedure at Clinique Hartmann (Neuilly-sur-Seine), which has full surgical facilities.

Reimbursement

Surgical removal of a deep contraceptive implant is reimbursed by the French health system (Assurance Maladie) on the basis of the standard tariff. Dr Zeitoun practises in Sector 2 (non-OPTAM) — additional fees apply. A detailed quote is provided at the pre-operative consultation. Your complementary health insurance may cover part or all of the additional fees depending on your plan.

Frequently asked questions

Where can I get a contraceptive implant removed in Paris?

A palpable contraceptive implant is removed at the practice under local anaesthetic in a few minutes. When the implant is deep, non-palpable, or a previous removal has failed, it must be removed in the operating room after ultrasound location. Dr Zeitoun handles both straightforward and complex contraceptive implant removals in Paris 8th and Neuilly-sur-Seine.

What should I do if my implant cannot be felt?

Do not attempt removal at the GP practice. X-ray and ultrasound imaging are required first to locate the implant precisely. Contact a specialist gynaecological surgeon for a pre-operative consultation.

Is surgical removal of a deep implant dangerous?

In the vast majority of cases it is safe for an experienced gynaecological surgeon. In rare situations involving deep migration near vascular structures, collaboration with a vascular surgeon may be arranged. The pre-operative imaging workup ensures your safety.

Is the procedure covered by insurance?

Yes, it is reimbursed by the French health system on the basis of the standard tariff. Dr Zeitoun practises in Sector 2 — additional fees apply, and a detailed quote is provided beforehand. Your complementary health insurance may cover the additional fees.

How long is recovery after removal?

Recovery is generally straightforward: return to a desk job within 3 to 7 days, no heavy lifting for one week, light sport after 2 to 3 weeks.

Dr Jérémie Zeitoun

Surgical oncologist, breast and gynaecological surgeon. Former specialist practitioner at Institut Gustave Roussy. Practices at Paris 8th (241 rue du Faubourg Saint-Honoré) and Clinique Hartmann, Neuilly-sur-Seine..

About Dr Zeitoun →

Consultation

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Comparison

Which localisation technique?

The choice depends on implant depth and local anatomy.

Implant	Localisation technique	Indication	Timeline	Anaesthesia
Palpable	None needed	Superficial implant	Immediate	Local
Non-palpable	High-frequency ultrasound	Depth < 1 cm	1-2 weeks	Local or general
Migrated	Dedicated MRI	Depth > 1 cm	2-4 weeks	General
Fragmented	US + MRI combined	Broken implant	2-4 weeks	General

Source: HAS, CNGOF, ACOG, ESMO, NICE guidelines.

Sources & references

Scientific bibliography

This article draws on guidelines from learned societies (HAS, CNGOF, ACOG, NICE, ESMO) and on recent peer-reviewed literature.

Power J, French RS, Cowan FM. Subdermal implantable contraceptives versus other forms of reversible contraceptives. Cochrane Database Syst Rev. 2007;(3):CD001326. PubMed 17636662.
Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care. 2008;13(suppl 1):13-28. PubMed 18330814.
Iwanaga J, Fox MC, Rekers H, et al. Localization techniques for guided removal of non-palpable Implanon. Contraception. 2017;95(2):144-149. PubMed 27741393.
Reed SD, Zhou X, Ichikawa L, et al. Removal of nonpalpable etonogestrel implants. Obstet Gynecol. 2019;133(2):343-350. PubMed 30633134.
FSRH. Progestogen-only Implant guideline. Faculty of Sexual & Reproductive Healthcare. fsrh.org.
Patel A, Patel S, Patel B. Surgical removal of contraceptive implants in difficult cases. J Family Plann Reprod Health Care. 2014;40(3):216-218. PubMed 24263822.
Haute Autorité de Santé (HAS). Contraception : prescriptions et conseils aux femmes. has-sante.fr.
CNGOF. Recommandations pour la pratique clinique : contraception. cngof.fr.
Mansour D, Korver T, Marintcheva-Petrova M, Fraser IS. The effects of Implanon on menstrual bleeding patterns. Eur J Contracept Reprod Health Care. 2008;13(suppl 1):13-28. PMID: 18330814.
Iwanaga J, Fox MC, Rekers H, et al. Localization techniques for guided removal of non-palpable Implanon. Contraception. 2017;95(2):144-149. PMID: 27741393.
Reed SD, Zhou X, Ichikawa L, et al. Removal of nonpalpable etonogestrel implants. Obstet Gynecol. 2019;133(2):343-350. PMID: 30633134.

Article written and medically reviewed by Dr Jérémie Zeitoun, gynaecological surgeon in Paris, former specialist practitioner at Institut Gustave Roussy. Last updated: 8 May 2026.

This article is for information only and does not replace an individual medical consultation.

FREQUENTLY ASKED

Quick answers

Why does an implant become deep?

Poor insertion technique, progressive migration, significant weight gain, local trauma. Affects <1% of implants.

How do I know if my implant is deep?

If not palpable on clinical exam. Confirmed by ultrasound or MRI. 5% of implants are difficult to palpate.

Is OR removal painful?

No: local or short general anaesthesia. Intra-operative ultrasound localization. 30-60 min.

How long to recover?

1-3 days rest from physical activity. Immediate resumption of daily activity. Dressing 5-7 days.

Risk of complications?

<1% major complications: infection, hematoma, vascular/nerve injury. Very well tolerated with adapted technique.