Deep implant removal: The impact of implant depth and positioning

This study assesses the factors associated with deep and complex implant placement, including the difficulties and need for surgical removal.

Our cross-sectional study was conducted at two centers in Argentina and Brazil, with users of etonogestrel implant who required removal. Healthcare providers recorded implant depth, location, presence of fibrosis, and need for surgical removal.

A total of 846 women were included, with a mean ± standard deviation age of 29.3 ± 7.4 years. Most implants (75.8%) were in an adequate location. We found that 91.4% of implants were palpable, while 16.5% were deeply placed. Surgical removal was required in 7.8% of the cases. After multivariate regression, we found that inadequate placement increased the likelihood of deep positioning by 17-fold (odds ratio [OR] 17.05, 95% CI 9.69; 30, P < 0.001), while fibrosis increased this risk by 2.2-fold (OR 2.27, 95% CI 1.23; 4.18, P < 0.001). Deep implants had a markedly increased likelihood of requiring surgical removal (OR 51.44, 95% CI 8.55; 309.55, P < 0.001), and fibrosis increased this risk by 9.66-fold (OR 9.66, 95% CI 1.15; 81.39, P = 0.037).

Difficult implant removals, including surgical extractions, are strongly associated with inadequate placement and fibrosis. These factors significantly increase the complexity of removal, emphasizing the need for proper insertion training and early identification of high-risk cases to reduce surgical interventions.