In 2011 Merck Sharp & Dohme (MSD) introduced a new etonogestrel (ENG) implant, Nexplanon, with a different type of insertion technique from its predecessor, Implanon. Over subsequent years it has become clear that the problem of incorrect placement of ENG implants, which are then unsuitable for removal using standard techniques, has continued. An effective and safe technique is needed to remove such implants, particularly for women wishing to conceive.
The correct plane of insertion is 1–2 mm below the skin surface, where the implant is readily palpable and can usually be removed using the ’pop-out’ technique. When insertion is deep to the subdermal layer, implants become more difficult to palpate and remove. However the term ’deep’ is too limited to explain the range of depths and different degrees of difficulty encountered with removal. An implant that is deep to the subdermal layer but superficial to the biceps or triceps fascia will…