Society of Family Planning issues first guidance on deep and nonpalpable contraceptive implant removal

The Society of Family Planning has released first-of-its-kind evidence-informed guidance on the management and removal of deep and nonpalpable contraceptive implants, published in Contraception and endorsed by the North American Society for Pediatric and Adolescent Gynecology and the Planned Parenthood Federation of America.^1,2

Contraceptive implants are highly effective, long-acting reversible contraceptive rods placed subdermally in the upper arm. The only FDA-approved and marketed contraceptive implant in the United States is etonogestrel 68 mg (Nexplanon; Organon), approved for 5 years of pregnancy prevention.^1,3 Although most implants can be removed by a trained clinician during a routine office visit, implants placed too deeply, in an incorrect location, or that have migrated significantly may not be fully palpable, making localization and removal challenging.^1,2

“The true incidence of deep or nonpalpable contraceptive implants is unknown, but cohort studies suggest it is rare,” wrote the authors of the Committee Statement, with 1 large cohort study reporting deep placement at a rate of 8.8 per 1,000 placements (95% CI, 6.8–11.2).¹ Factors associated with difficult removal include a nonpalpable implant immediately after placement, weight gain since placement, and longer duration of use.

“Most deep or nonpalpable contraceptive implant removals can occur in an outpatient setting, but awareness, clinical recommendations, and referral opportunities have been limited,” said lead author Paula Castaño, MD, MPH, associate professor of obstetrics and gynecology at Columbia University Vagelos College of Physicians and Surgeons and a member of the COE Steering Panel.

“This guidance, combined with a growing, publicly available network of referrals, seeks to advance equitable access to timely contraceptive discontinuation by preventing delays in care, unsuccessful removal attempts and referrals for unnecessary surgery,” Castaño added.

Guidance recommended for localization and removal

The Committee Statement outlines a standardized protocol for approaching deep or nonpalpable implant removal, beginning with palpation to confirm implant location.¹ If the implant is not fully palpable, the guidance recommends imaging prior to any removal attempt.

Specifically, the authors wrote, “If clinicians cannot palpate either end of the contraceptive implant in either arm with certainty, or the placement scar is not visible and an alternate placement location is excluded; they should perform or obtain imaging to confirm location prior to removal attempt. Appropriate radiologic evaluation can help determine the location of an implant that is only partially palpable or nonpalpable, as palpation alone cannot determine if an implant is subdermal, deeper within subcutaneous adipose tissue, or in suprafascial, intrafascial, or subfascial (intramuscular) locations.”

Ultrasonography using a high-frequency linear array transducer greater than 10 MHz is the first-line imaging modality, as it is effective, low-cost, and free of ionizing radiation. Radiography confirms presence or absence of radiopaque implants when ultrasonography is unavailable or inconclusive. MRI may be used for non-radiopaque implants.

Clinicians inexperienced in advanced removal techniques should not attempt deep or nonpalpable implant removal without localization and direct supervision by an experienced clinician. Case reports and series show that one-quarter to one-half of persons referred for deep or nonpalpable implant removal have prior failed removal attempts, sometimes resulting in disfiguring scars distant from the actual implant location.

The U-clamp technique, using a modified vasectomy clamp with a 2.2-mm ring diameter, represents the most widely reported approach for outpatient removal, with experienced clinicians reporting successful removal rates of 98.1% to 100% for suprafascial and 86.1% to 90.5% for subfascial implants. Emerging techniques including curved needle fixation and hydrodissection with Hartmann grasping microforceps are also described in the guidance.

What is the role of Centers of Experience?

To support timely referrals, the Society of Family Planning launched a publicly searchable national directory of Contraceptive Implant Centers of Experience (COEs), featuring clinicians who specialize in removing deep, complex, and nonpalpable contraceptive implants. The COE directory currently includes more than 180 clinicians across 38 states and Washington, DC.²

“Advancing just and equitable healthcare requires pairing rigorously developed guidance with sustained attention to how care is delivered in practice,” said Amanda Dennis, DrPH, MBE, president of the Society of Family Planning. “The Society convened leading experts to address the gap in clinical guidance on complex contraceptive implant removal, while actively leveraging our clinician network to build seamless referral pathways.”

The guidance emphasizes that facilitating access to timely removal whenever requested is a matter of health equity and person-centered care, and that removal requests should be honored without pressure or bias, regardless of the clinician’s personal preferences.¹ The statement acknowledges that coercive contraceptive practices have disproportionately affected people of color, those with disabilities, those experiencing socioeconomic marginalization, and people in immigrant and carceral communities.

“To promote reproductive justice and personal autonomy, equitable access to timely removal by skilled clinicians with the needed resources is critical,” wrote the authors.

Contraceptive implant removal key clinical recommendations

The Committee Statement includes the following core recommendations:

• Proper subdermal placement technique during insertion minimizes the need for deep or nonpalpable removal
• Clinicians should be familiar with upper arm anatomy before attempting removal, given proximity to the brachial artery, ulnar and median nerves, and basilic vein
• A standardized protocol addressing localization, positioning, depth measurement, instrument selection, and removal technique should be followed
• When a contraceptive implant is not localizable in either arm, clinicians should consider alternate placement location, migration, or absence
• Neuropathic symptoms following removal are uncommon and transient, with most resolving within 1 month postprocedure and all resolved by 6 months
• Appropriate diagnostic and procedural coding should be used to accurately reflect the complexity of deep or nonpalpable removal services¹

To view the complete guidance, visit the Society of Family Planning website here.⁴

References:

1. Castaño PM, Creinin MD, Eisenberg DL, et al. Society of Family Planning Committee Statement: Management and removal of deep and nonpalpable contraceptive implants. Contraception. Published 2026. doi:10.1016/j.contraception.2026.111567
2. Society of Family Planning. News release: The Society releases clinical guidance addressing contraceptive implant removal, expands pathways to timely care. Published August 31, 2026. Accessed September 10, 2026. https://societyfp.org/about/society-statements/news-release-the-society-releases-clinical-guidance-addressing-contraceptive-implant-removal-expands-pathways-to-timely-care/
3. Fitch J. FDA approves 5-year use for etonogestrel implant 68 mg contraceptive. Contemporary OB/GYN. Published January 19, 2026. Accessed September 10, 2026. https://www.contemporaryobgyn.net/view/fda-approves-5-year-use-for-etonogestrel-implant-68-mg-contraceptive
4. Management and removal of deep and nonpalpable contraceptive implants. Society of Family Planning. August 2026. Accessed September 10, 2026. https://societyfp.org/clinical_guidances/management-and-removal-of-non-palpable-contraceptive-implants/