Quick Answer
Most of the time, stitches are not required after Nexplanon removal. The implant is removed through a small incision in the arm, which typically heals on its own without the need for stitches. However, in some cases the provider may use a stitch or two to close the incision. This is more likely if there is bleeding that needs to be controlled or if the incision is larger than normal. Overall, stitches are not routinely necessary and most patients can expect their incision to close up with simple bandaging after Nexplanon removal.
What is Nexplanon?
Nexplanon is a hormone releasing birth control implant that is inserted under the skin of the upper arm. It is a small, thin rod about the size of a matchstick that releases progestin to prevent pregnancy for up to 3 years. The progestin thickens cervical mucus to prevent sperm from reaching the egg and also thins the uterine lining to prevent implantation of a fertilized egg.
Nexplanon contains 68 mg of etonogestrel, which is released slowly and steadily over time. The implant provides highly effective birth control with a failure rate of less than 1%.
The Nexplanon implant is inserted using a special applicator by a healthcare provider during an office visit. It is placed under the skin on the inside of the upper arm. Once inserted, it prevents pregnancy 24/7 for up to 3 years. At the end of 3 years it must be removed and replaced if continued birth control is desired.
Nexplanon Removal Procedure
Removal of Nexplanon is a quick and simple office procedure. It is typically removed 3 years after the initial insertion, or sooner if the patient desires. Here are the basic steps for Nexplanon removal:
- The arm is cleaned and numbed with anesthetic.
- A small incision is made in the arm near the implant.
- Using the tip of a scalpel, the healthcare provider locates the implant.
- The implant is gently pushed to the surface and removed using forceps.
- Pressure is applied until the bleeding stops.
- A bandage is applied.
The entire removal process takes only 5-10 minutes. Patients are awake during the procedure but the arm is numbed so only minor discomfort is felt.
Are Stitches Needed After Nexplanon Removal?
In most cases, dissolving stitches are not necessary after Nexplanon removal. The incision is less than 1/4 inch long and normally heals well on its own once the implant is taken out. Here are some reasons why stitches may not be needed:
- The incision is small and easy to close up by applying pressure.
- Medical grade surgical glue can be used to seal the incision.
- The arm can be bandaged with gauze, a special sealing bandage, or sterile strips.
- The natural clotting process closes up the incision site.
Applying pressure with gauze for 5-10 minutes is typically enough to stop any minor bleeding or fluid seepage after the implant is removed. The skin naturally reseals itself and stitches are not required.
Bandaging After Nexplanon Removal
Instead of stitches, most doctors will bandage the arm after Nexplanon removal. This helps protect the incision and promotes healing. Bandaging options include:
- Adhesive bandage – After bleeding stops, a regular adhesive bandage can be applied.
- Butterfly stitches – These mild sterile tape strips pull the skin together.
- Liquid bandage – This self-sealing glue is applied over the wound.
- Gauze and medical tape – Layers of gauze secured with medical tape.
- Coban – This self-adherent wrap gently compresses the area.
The bandage should be kept clean and dry for 24-48 hours. The arm may feel slightly tender but normal use can be resumed. The bandage can be removed after 1-2 days.
When Might Stitches Be Necessary?
While not typical, there are some instances where a provider may opt to place one or two stitches to close the incision after Nexplanon removal:
- Bleeding does not stop – If bleeding continues despite applied pressure, a stitch may control it.
- Large incision – If a larger than normal incision was needed, a stitch may close it.
- Infection – A stitch could help close an incision in case of site infection.
- Reinsertion – If a new implant is being inserted, a stitch may close the incision.
- Scarring – Stitches could minimize scar formation for cosmetic reasons.
Other factors like blood thinning medications, bleeding disorders, or incision placement could warrant a stitch too.
Overall though, stitches are not considered necessary for most routine Nexplanon removals. Simple bandaging is usually enough for the arm to heal on its own.
Signs Stitches Might Be Needed
Here are signs during the Nexplanon removal process that indicate placing a stitch or two may be appropriate:
- Bleeding continues after 10 minutes of pressure
- The incision edges gape open widely
- The implant site feels unstable
- Any signs of infection are present
- The patient requests a stitch for cosmetic reasons
- Reinsertion of a new implant is planned
Evaluating these factors can help the provider determine if closure with a stitch is preferable to help the incision heal optimally after the removal procedure.
What to Expect After Nexplanon Removal
Recovery after Nexplanon removal is quick and easy for most patients. Here is what to expect:
- Keep the bandage clean and dry for 1-2 days.
- Mild bruising, swelling, or redness may occur and resolve in a week or two.
- Use a cold pack to help minimize arm swelling or discomfort.
- Avoid heavy lifting, exercise, or repetitive arm motions for a few days.
- Take over-the-counter pain relievers as needed for soreness.
- The incision will fully close in 5-7 days.
- If a stitch was used, it will dissolve and not require removal.
- Resume normal activities as tolerated once initial healing occurs.
Signs of Infection
Contact your healthcare provider if any signs of infection develop:
- Increasing pain, swelling or redness at incision site
- Pus or foul-smelling drainage from the incision
- Warmth and tenderness around the incision
- Fever over 100°F (37.8°C)
Infection is uncommon but requires medical treatment with antibiotics. Most patients have an easy recovery with no complications after Nexplanon removal.
Scarring After Nexplanon Removal
Some minor scarring will occur since an incision is made to remove Nexplanon. However, in most cases the scar fades significantly over time. Here is what to expect:
- Scars form during the natural healing process.
- The scar may start out pink or red but fades over many months.
- Keep the area moisturized daily with lotion to hydrate the scar.
- Massage the site to break up scar tissue and improve circulation.
- Silicone sheeting or gel can minimize and flatten the scar.
- Avoid direct sun exposure which can darken the scar.
- It takes 12-18 months for the scar to fully mature and fade.
While the scar may remain slightly visible, it is often faint and not very noticeable over time. No ongoing care for the scar is required unless it becomes raised, thickened, or painful which can indicate scarring complications. Discuss any cosmetic concerns about scarring with your provider.
Risks and Complications
Nexplanon removal is a very safe and effective procedure. Most patients have no issues and heal quickly with no lasting effects. However, as with any procedure, some possible risks include:
- Bruising, swelling, bleeding or discomfort at the removal site
- Numbness or tingling around the incision that resolves in days to weeks
- Scarring and skin discoloration at the site of incision
- Difficulty removing implant if deeply embedded or encased in fibrous tissue
- Rare risks of nerve damage or infection
Discuss any specific concerns with your healthcare provider prior to the removal procedure. Be sure to follow all post-procedure instructions to minimize risks and support proper healing.
When to Seek Medical Care
Contact your healthcare provider if you experience:
- Signs of infection like increasing pain, heat and pus
- Uncontrolled bleeding from the incision
- Extreme pain or swelling that is worsening
- No improvement within 1-2 weeks
- Scar appears raised, thickened or enlarged
Prompt medical care can address any complications or issues with healing after Nexplanon removal.
Cost of Nexplanon Removal
The cost for Nexplanon removal can range from $0 to $300 or more without insurance. The price varies based on factors like:
- Geographic location – Prices are higher in major metro areas
- Type of clinic – Hospital vs. independent clinic costs
- Provider qualifications – OB/GYN vs. family medicine doctor fees
- Use of anesthesia – Local numbing increases costs
Many insurance plans cover Nexplanon removal in full after paying the copay, usually $15 to $75 if performed by an in-network provider. Confirm coverage specifics with your insurance. Some ways to reduce costs are having it removed when due instead of early and using a clinic with lower prices.
Will Insurance Cover It?
In many cases insurance will fully cover Nexplanon removal as part of contraceptive care:
- Most ACA health plans cover it without co-pays or deductibles
- Medicaid family planning programs provide free removal
- It must be performed by an in-network provider
- Coverage for early removal outside 3 year life may require a medical reason
Verify your individual plan’s specific coverage for contraceptive implant removal. Out of pocket costs are lowest when guidelines are followed.
Finding a Healthcare Provider
Nexplanon must be inserted and removed by a licensed healthcare provider trained in the procedure. It is best to have it removed by the same provider that inserted it if possible. Sources to find a provider include:
- Your obstetrician / gynecologist (OB/GYN)
- A family medicine doctor or nurse practitioner
- Your local health department
- Planned Parenthood health centers
- University medical clinics and student health centers
When scheduling removal, verify the provider is experienced with Nexplanon. You can also check your insurance plan’s list of in-network contraceptive providers.
Questions to Ask When Choosing a Provider
Here are some important questions to ask when selecting a removal provider:
- How many Nexplanon removals have you done?
- Do you make the incision in the same location as insertion?
- Will I be given local anesthesia during the procedure?
- What type of bandaging and aftercare do you provide?
- Can stitches be used if needed for closure?
- Do you submit a claim to my insurance company?
Choosing an experienced provider helps ensure proper technique and minimizes risks and complications.
When to Schedule Removal
Nexplanon prevents pregnancy for 3 years after insertion. It should be removed right around the 3 year mark.
- Can be removed anytime after 3 years
- Should ideally be removed by the end of year 3
- Leaving it longer than 3 years is not recommended
- Once removed, fertility returns to normal quickly
Schedule a removal appointment 2-3 months prior to the 3 year date to ensure timely access. Calendars fill fast with routine office visits so plan ahead. Missing the 3 year removal deadline risks unintended pregnancy.
Early Nexplanon Removal
While intended to remain in place for 3 years, early removal may occur for reasons like:
- Desire to get pregnant
- Hormonal side effects
- Partial expulsion
- Pain or injury to the arm
- Planned surgery on the arm
- Weight changes
Elective early removal is possible but may not be fully covered by insurance unless specific medical criteria are met. Talk to your provider to determine if early removal is appropriate for your situation.
Inserting a New Nexplanon
If ongoing birth control is desired, a new Nexplanon implant can be inserted immediately after removing the old one:
- This avoids gaps in contraceptive coverage.
- The new implant goes into the same site as the old one.
- Quick removal and replacement takes only 10-15 minutes.
- Using the existing scar minimizes additional scarring.
- Consider a different birth control method if side effects occurred.
Alternatively, a new Nexplanon can be placed in the opposite arm if preferred. Discuss options with your provider to determine if replacement is right for you.
Conclusion
In most cases stitches are not necessary after Nexplanon removal. The tiny insertion site generally closes quickly with simple bandaging and heals within 5-7 days. While less common, one or two stitches may be appropriate if the incision is large, bleeding persists, or infection is present. This helps control bleeding and optimize healing. Overall complications are rare and recovery is fast and simple for the majority of patients after Nexplanon removal. Following your provider’s instructions supports the best results.
