Dr Elliman1 asked whether other clinicians had experience of damaged implants. Dr Rekers2 replied that breakage is rare and would not alter contraceptive efficacy.

I have removed damaged implants from seven patients since June 2011, all of which were sited correctly. Two patients underwent subsequent removal of a second damaged implant. All the patients were aware of abnormality, but only one remembered trauma. One had positive home pregnancy tests from 3 days after implant removal, suggesting method failure.

The first patient requested exchange of a bent Nexplanon^® at 10 months. She described an injury 4 months previously. She felt unwell and had experienced recent heavy bleeding in place of the initial amenorrhoea. Pickard and Bacon3 described bleeding in association with a damaged implant. I chose incision over the bend but found that the two halves were attached by the rate-limiting membrane.

The second …