I read with interest the letter by Dr Kandiyil on a method for removal of Implanon^® in the July 2012 edition of this Journal.1 The method describes stabilising the implant prior to its removal.

Inserting a needle is an unnecessary trauma and carries the risk of damage to structures in the arm, especially in thin persons.

I find it easier and less traumatic to remove an implant, as far as possible, through the site of its insertion provided this is in close proximity to its lower end. A small amount, usually 1 ml, of local anaesthesia is injected subdermally under the tip of the implant. This prevents oedema between the tip and the surface skin and so facilitates easy palpation of the former while affording analgesia for the procedure. The overlying skin is stretched (tenting) by the tip of the implant, which is pushed down. An incision on the stretched skin over the tip is made and through this the fibrous capsule around the end of the implant is breached. Often the implant pops out with ease.

As always, the ease of removal of an implant is facilitated by the device being correctly deployed subdermally at the time of insertion.