Deep Contraceptive Implant Removal — Surgical Extraction

Recognising the situation

When the implant escapes simple removal

The contraceptive implant (Nexplanon) is normally placed just beneath the skin on the inner arm. In some patients, it migrates progressively towards deeper tissues — muscular fascia, median nerve or brachial vessels — and becomes impossible to remove in the consultation room with a simple incision. This is referred to as a too-deep, non-palpable or encased implant.

Non-palpable

The implant can no longer be felt under the skin — first sign of deep migration.

Inaccessible

Removal in the consultation room has failed or cannot be performed without risk to neurovascular structures.

Encased

Fibrosis around the implant makes extraction even more delicate without direct surgical visualisation.

01

Implant no longer palpable on the inner arm

The small rod you used to feel under the skin can no longer be detected by touch.

02

Removal attempt in the consultation room interrupted or failed

The practitioner was unable to locate or extract the implant by simple incision.

03

Pain or tingling in the arm, forearm or hand

Sign of proximity to nerve structures — consult without delay.

04

Removal scar without implant found

The implant was not removed despite an incision — urgent imaging workup required.

Understanding

Why does the implant migrate deep?

Several mechanisms can lead to a too-deep implant. Identifying them helps better anticipate the surgical management.

Cause 1

Initial insertion too deep

If the insertion needle is not perfectly tangential to the skin, the implant is deposited directly in the muscular tissue or fascia rather than in the superficial subcutaneous tissue. This risk is higher in women with little subcutaneous fat.

Cause 2

Secondary migration

The implant is correctly placed initially but migrates over time. Contributing factors: intense physical activity involving the arms (weightlifting, combat sports), low BMI, repeated arm trauma.

Cause 3

Fibrous encasement

The body forms a fibrous capsule around the implant. Even without deep migration, this peri-implant fibrosis makes extraction impossible in the consultation room without direct visualisation.

Key point

Structures at risk

When migrating into the fascia, the implant may come into contact with the medial cutaneous nerve of the forearm, the brachial artery or basilic vein — which is why any blind removal attempt is contraindicated.

Pre-operative workup

X-ray and ultrasound of the arm: why both?

Before any surgical procedure, an imaging workup is essential to precisely locate the implant and plan the removal safely. Two complementary examinations, prescribed by your doctor and covered by the French National Health Insurance.

X-ray of the arm

Confirming presence and location

Nexplanon is radio-opaque thanks to the barium sulphate it contains. The X-ray confirms its presence in the arm, rules out thoracic migration (exceptional but documented), and situates its general position.

Ultrasound of the arm

Precise depth and trajectory

The key examination. The ultrasound precisely determines the exact depth of the implant, its trajectory, its relationship with adjacent nerves and vessels, and the presence of peri-implant fibrosis.

Bring your imaging to the consultation

Ask your radiologist for the written report and images. If you have not yet had these examinations, Dr Zeitoun can direct you to appropriate radiologists. Do not attempt removal without prior imaging — a blind attempt can damage the nerves or vessels of the arm.

Protocol in 3 steps

From imaging to removal

01

X-ray and ultrasound assessment of the arm

The X-ray confirms the presence and general location of the implant (radio-opaque). The ultrasound precisely determines its exact depth, trajectory and relationship with neurovascular structures. This assessment is performed before the surgical consultation.

02

Surgical consultation and quote

Dr Zeitoun analyses the imaging, evaluates the anatomical situation and discusses the procedure with you. A detailed quote is provided. If a prior agreement with your insurer is required, the practice assists you with the process.

03

Removal in the operating theatre under local anaesthesia

Approximately 10-minute procedure in the operating theatre in a private hospital setting. Short incision, careful dissection with preservation of nerve and vascular elements. Return home the same day.

What you need to know

Before, during, after

1

Bring your imaging results

X-ray and ultrasound of the arm performed in advance. If you do not yet have these examinations, Dr Zeitoun can direct you to appropriate radiologists.

2

Local anaesthesia — no general anaesthetic

The procedure is performed under local anaesthesia only. No general anaesthetic, no prior anaesthetic consultation required in the majority of cases.

3

Duration: approximately 10 minutes

The procedure itself is brief. Allow a half-day for the whole process (arrival, preparation, procedure, immediate post-operative monitoring).

4

Simple recovery

Dressing to be kept on for 48 hours. Mild pain for the first few days, managed with simple analgesics. Return to everyday activities in 2 to 5 days. No heavy lifting for 1 week.

5

Contraception after removal

The contraceptive effect ceases immediately after removal. Plan alternative contraception if necessary — Dr Zeitoun will discuss this with you during the consultation.

Operating theatre · Private sector

The procedure is performed in the operating theatre, in a private hospital setting. Full technical facilities — equipped operating theatre, dedicated nursing team. Day surgery — arrival in the morning, return home the same day.

Coverage

Reimbursable procedure by French National Health Insurance. Quote provided during the consultation. Sector 2 — additional fees may apply.

Frequently asked questions

What patients often ask

My implant is too deep — what should I do concretely?▾

Start by having an X-ray and ultrasound of the arm if not already done, to precisely locate the implant. Bring these results to a consultation with Dr Zeitoun, who will assess the situation and provide a quote for the procedure. Removal will then be scheduled in the operating theatre at Clinique Hartmann.

Why can an implant migrate deep?▾

The implant is normally placed just beneath the skin on the inner side of the arm. Depending on tissue characteristics, the initial position during insertion and physical activity, it can progressively migrate into the muscular fascia or near neurovascular structures, becoming non-palpable and inaccessible by simple incision in the consultation room.

Why have both an X-ray AND an ultrasound before the procedure?▾

The X-ray confirms the presence and general position of the implant, which is radio-opaque. The ultrasound precisely determines its exact depth, trajectory and proximity to nerves and vessels. This dual assessment is indispensable for planning the surgical procedure safely.

Is the procedure painful?▾

No. The removal is performed under local anaesthesia in the operating theatre — you are conscious but the area is completely numb. The procedure lasts approximately 10 minutes. Recovery is simple: mild pain for the first few days managed with simple analgesics, dressing to be kept on for 48 hours, return to activities in 2 to 5 days.

Is the procedure covered by health insurance?▾

Surgical removal of a deep contraceptive implant is a reimbursable procedure by the French National Health Insurance. In sector 2, additional fees may apply. A detailed quote is systematically provided during the consultation, before any procedure.

What happens to my contraception after removal?▾

The contraceptive effect ceases immediately after removal of the implant. If you do not wish to become pregnant, it is important to plan alternative contraception before or immediately after removal. Dr Zeitoun will address this subject during the pre-operative consultation.