Nexplanon removal is not surgery in any meaningful sense of the word. It’s a minor office procedure that takes about one minute, uses a tiny skin incision of 2 to 3 millimeters, and requires only a local numbing injection. You don’t need an operating room, general anesthesia, or any hospital stay.
What Actually Happens During Removal
The entire removal takes place in a regular clinic or doctor’s office. Your provider first feels for the implant under your skin, then injects a small amount of lidocaine (the same numbing agent dentists use) right at the spot where the incision will be made. Once the area is numb, they make a cut about 2 mm long with a scalpel, push the tip of the implant toward the opening, and pull it out with forceps.
In a clinical study of over 300 removals, the median procedure time was 60 seconds. Even at the slower end, most removals wrapped up in under two minutes. The longest recorded removal in that study took about seven minutes. From the moment you sit down to the moment you leave, the full appointment is considerably longer than the removal itself, mostly because of paperwork, numbing, and aftercare instructions.
Why It Feels Different From Surgery
Surgery typically involves an operating room, sedation or general anesthesia, a surgical team, and a recovery period. Nexplanon removal has none of that. The incision is smaller than a pencil eraser. There are no stitches in most cases. You can drive yourself home and go about your day. The experience is closer to getting a mole removed or having blood drawn than to anything you’d think of as an operation.
That said, providers who perform the removal do need specific certification. The manufacturer requires clinicians to complete a training program that includes a knowledge assessment, didactic coursework, and in-person practical training before they’re authorized to insert or remove the implant. This isn’t because the procedure is dangerous. It’s because locating and extracting a small rod from under the skin requires a particular skill set.
The One Exception: Deep or Non-Palpable Implants
In rare cases, an implant migrates deeper into the arm or can’t be felt through the skin. These removals are more involved. A provider will use ultrasound imaging to locate the implant and guide the extraction in real time, sometimes injecting fluid around the implant to separate it from surrounding tissue. Even this version is typically done as an outpatient procedure under local anesthesia, with no hospital admission required.
A study of 30 non-palpable implants found that 87% were successfully removed using this ultrasound-guided technique through a small incision. The cases that failed were mostly implants sitting beneath the muscle fascia rather than in the fat layer under the skin. When the minimally invasive approach doesn’t work, the implant can be removed through a slightly larger incision, which is the closest the process gets to what you’d call surgery. This scenario is uncommon, and your provider will know beforehand if your implant is in a tricky position.
Recovery After Removal
There’s very little to recover from. You’ll have a small adhesive bandage or pressure wrap over the incision site. Some bruising and mild tenderness around the area is normal for a few days. The incision is so small that scarring is minimal. Most people don’t need any pain relief afterward, though over-the-counter options are fine if the spot feels sore once the numbing wears off.
There are no significant activity restrictions. You may be told to keep the bandage dry for a day or two and to avoid heavy lifting with that arm for 24 hours, but these are precautions rather than requirements for healing.
Getting Pregnant or Replacing the Implant
If you’re having the implant removed because you want to get pregnant, fertility returns quickly. There’s no waiting period after removal. If you want to continue using this method of birth control, a new implant can be placed through the same incision during the same appointment. You can also switch to a different contraceptive method the same day. If you don’t have a new implant placed or start another method, you can become pregnant right away.
Implant Breakage During Removal
One concern people sometimes search for is whether the implant can break during removal. This is extremely rare. Only a handful of cases of in-situ fracture have been reported in the medical literature, and the true incidence is unknown because it happens so infrequently. If a break does occur, your provider can typically retrieve both pieces through the same small incision, sometimes with the help of ultrasound.