Three Concurrent Nonpalpable Nexplanon Implants in the Upper Arms Following Presumed Failed Insertions: A Case Report.

INTRODUCTION: Subdermal etonogestrel implants (Nexplanon) are a widely used form of long-acting reversible contraception, providing up to 5 years of pregnancy prevention. Their ease of outpatient insertion and high efficacy have contributed to their widespread use. However, correct subdermal placement and immediate postinsertion confirmation of palpability are essential to ensure proper positioning and facilitate future localization and removal. CASE PRESENTATION: We report the case of a 42-year-old G1P1001 patient who was ultimately found to have three nonpalpable concurrent Nexplanon implants in both upper arms following multiple presumed failed insertion attempts over several years. On several occasions, newly placed implants were not palpable after insertion and were assumed to represent failed deployment, leading to repeat insertions without imaging confirmation. At presentation to our institution, high-frequency ultrasound identified a total of three nonpalpable, but superfascial, implants: two in the left upper arm and one in the right upper arm. All devices were successfully localized and removed in an outpatient setting using ultrasound-guided techniques without complication. DISCUSSION: Nonpalpable contraceptive implants most commonly result from deep insertion into subcutaneous, fascial, or intramuscular tissue. Most published reports describe single retained implants managed with high-frequency ultrasound as the first-line modality for localization and removal. This case is unique in demonstrating the cumulative consequence of repeated misinterpretation of nonpalpability as failed insertion, resulting in multiple retained devices across both upper arms. It highlights a critical gap in procedural verification and reinforces the importance of standardized postinsertion confirmation protocols.