Fractured Nexplanon® implant.

I read Hans Rekers’ 2013 letter about removal of a fractured Nexplanon implant with interest, as I have in my practice come across a Nexplanon implant that was completely fractured through its core and sheath in two discrete locations (Figure 1), a scenario that I had not encountered previously. A 44-year-old woman had had a Nexplanon implant inserted 3 years previously. She was amenorrhoeic for the last 18 months, and denied having any problems with the device or any history of trauma to the implant. On routine removal and replacement I could feel the broken implant under the patient’s skin about 1.5 cm from the insertion site. The implant was removed using the ‘pop-out’ technique, whereby I was able to tease out two portions of the implant but was unable to remove the final remaining section. I had to make another incision higher up the patient’s arm in order to retrieve the third fragment. I have never encountered an Implanon implant that has been completely broken (core and sheath) in two places. As Janet Bentley noted in her letter about the removal of damaged implants, Nexplanon differs from Implanon in that it contains barium sulphate. I wondered whether using barium in the formulation might have made the Nexplanon implant more brittle than the Implanon device it replaced?