Non-Palpable Contraceptive Implant Removals: Experience From a Referral Center [5P

Abstract

INTRODUCTION: To describe our experience as a non-palpable contraceptive implant referral center, including office removal of subfascial implants. METHODS: We reviewed the charts of 46 patients seen in our Family Planning subspecialty center for non-palpable contraceptive implant removal from March 2015 through August 2018. Non-palpable implants were localized using high-frequency ultrasonography and skin mapping. We extracted information on demographics, implant location, and outcomes. We used Fisher exact testing for dichotomous variables. IRB-approved. RESULTS: Five women had palpable implants of which four chose to have removal. Ultrasound localization was performed for the other 41 women; one was not visualized and was identified on computed tomography imaging. Implants were intrafascial (n=1), suprafascial (n=15), and subfascial (n=25). The patient with intrafascial placement chose to continue use. Two patients with a subfascial implant opted to delay removal. We completed all 15 attempted suprafascial implant removals and 19/23 (83%) attempted subfascial removals in the office. Three of the four failures had removal in the operating room with a collaborative orthopedic surgeon; the other patient sought surgical removal elsewhere. Post-procedure neuropathic pain complaints were reported after 7 (30%) subfascial and no suprafascial removals (P=.03). Non-palpable implants were subfascial in 1/8 (12%) obese and 24/33 (73%) non-obese women (P=.003). Eight (32%) subfascially located implants were inserted during a removal-reinsertion procedure through the same incision. CONCLUSION: At a specialized referral center, most subfascial implants can be removed in the office; some patients may experience limited post-procedure neuropathic pain. Most non-palpable implants in non-obese women are subfascial and in obese women are suprafascial.