I read with interest the letter about two cases of broken Implanon® by Maria Dolores Tomas-Tello and her colleague.1

I would like to share an experience I had with a bent Implanon 3 weeks ago.

I saw a young 19-year-old-woman who had an Implanon inserted 18 months ago in May 2009. She regularly felt her implant. Since insertion of the implant she had irregular infrequent bleeding but this was not a problem.

She attended our clinic in November 2010 concerned that she felt her implant had been bent for the past week. She had no hormonal side effects and her bleeding pattern was still infrequent and irregular. There was no history of trauma or injury to her arm.

On palpation the whole implant was easily palpable subdermally in the inner upper aspect of her left arm. However, halfway through the length of the implant there was clear give way, possibly a break. When the distal end of the implant was pushed the implant would tent the skin in the middle, rather than the proximal end tenting the skin. When the proximal end of the implant was pushed the implant would tent the skin in the middle, rather than the distal end tenting the skin.

Although the patient had no problems except that she was concerned that the implant was bent, it was difficult to reassure her that she could continue with it for another 18 months.

I offered to remove and replace the implant. She was happy with this suggestion. The implant was removed easily using the ‘pop out’ technique and this was replaced with Nexplanon®. The Implanon was not broken but there was a sharp bend in the middle.

The Summary of Product Characteristics (SPC) for Implanon or Nexplanon does not provide information about bent or broken implants.

Now that Nexplanon is radio-opaque, it would be interesting to know whether an X-ray could help in confirming whether an implant that feels bent on palpation is actually only bent and not broken. Patients may, however, feel more reassured if a bent implant is replaced.