Difficult removal of a deep implant using a traditional removal method.

I read with great interest the correspondence from Dr Kandiyil and Dr Shepherd about implant removal in the July Journal and also Dr Menon’s letter in the October issue. Journal readers might be interested to hear about a recent patient of ours, who was referred to the central family planning (FP) clinic from a peripheral FP clinic for deep implant removal. This 27-year-old woman presented with a 3-month history of irregular per vagina bleeding, having had an implant in situ for 3 years. The deep implant was not palpable from the time of insertion by either the patient or medical professionals. The implant was located deep under subcutaneous fat, as the patient had gained a significant amount of weight since the time of implant insertion. On examination the implant had migrated 2 cm from the point of insertion towards the axilla and to the bottom of the groove between the biceps and triceps. The exact position of the implant was determined using a transvaginal ultrasound probe. Lidocaine 2% with adrenaline was used as local anaesthesia and to reduce Letters to the editor