Use of needle localization for difficult Norplant removal [letter]

Many patients receiving the Norplant implant later request its removal. This is usually accomplished without incident. However the occurrence of difficult removals (reported to be around 13.2% by the manufacturer) increases with infection migration or improper insertion. Roentgenography fluoroscopy and ultrasonography have been used to find the capsules in these situations. When these methods are unsuccessful breast needle localization may be used. This letter describes a case in which a 16-year-old female requested removal of the implants 1 year after insertion because of a 40 pound weight gain. 3 of the capsules were removed with difficulty; 2 were removed 4 weeks later. The final capsule was unpalpable because of weight gain and a deep placement. Ultrasonography provided no information because of scarring and the deep location of the capsule. A roentgenogram again because of the capsules deep oblique position was of little assistance. A needle localization technique similar to that used in breast biopsies was attempted successfully. The capsule which was 1.75 cm deep was located and removed.