The implant should be inserted preferably on the day after the last active tablet (the last tablet containing the active substances) of the previous combined oral contraceptive or on the day of removal of the vaginal ring or transdermal patch. At the latest, the implant should be inserted on the day following the usual tablet-free, ring-free, patch-free or placebo tablet interval of the previous combined hormonal contraceptive when the next application would have been due. Not all contraceptive methods (transdermal patch, vaginal ring) may be available in all countries. Chloasma may occasionally occur, especially in women with a history of chloasma gravidarum. Women with a tendency to chloasma should avoid exposure to the sun or ultraviolet radiation whilst using Nexplanon. Finally, thank the patient for their time and offer them a leaflet summarising the key information related to the implant (e.g. Sexwise implant leaflet). Blasko JC, Ragde H, Schumacher D. Transperineal percutaneous Iodine-125 implantation for prostatic carcinoma using transrectal ultrasound and template guidance. Endocuerietherapy Hyperthermia Oncology. 1987; 3:131. [ Google Scholar]

Wilkinson DA, Lee EJ, Ciezki JP, Mohan DS, Zippe C, Angermeier K, Ulchaker J, Klein EA. Dosimetric comparison of pre-planned and or-planned prostate seed brachytherapy. Int J Radiat Oncol Biol Phys. 2000; 48(4):1241–1244. doi: 10.1016/S0360-3016(00)00734-3. [ PubMed] [ CrossRef] [ Google Scholar] Huang W, Lu J, Chen KM, et al. Preliminary application of 3D-printed coplanar template for iodine-125 seed implantation therapy in patients with advanced pancreatic cancer. World J Gastroenterol. 2018;24(46):5280–7. If the tip of the implant does not become visible in the incision, gently insert forceps (preferably curved mosquito forceps, with the tips pointed up) superficially into the incision (Figure 17).

When to get the implant fitted

An implant inserted more deeply than subdermally (deep insertion) may not be palpable and the localisation and/or removal can be difficult (see section 4.2 How to remove Nexplanon and section 4.4). The implant can stay in place for up to 3 years, so you’ll need to remember when it needs to be removed and replaced. show the woman how to locate the implant and advise her to do this occasionally; if she has any concerns, she should return promptly to the clinic for advice

Using patient-friendly language, explain that the implant is a form of long-acting reversible contraception (commonly referred to as LARC methods or ‘fit and forget’ methods). When explaining potential advantages and disadvantages, you should consider the patient’s ideas, concerns and expectations (identified earlier in the consultation). You should always be able to feel the implant under your skin. You will be shown where to feel for this and what it feels like when you have your implant inserted.”As the implanter pen allows a surgeon to be more precise in his placement of the graft, if you wanted transplantation into a zone of thinning hair this can be achieved. This allows for even better coverage and precision when it comes to hair transplantation. However, there are some considerations with regards to DHI hair transplant surgery:

Contour delineation for the prostate target and organs at risk was performed on the TRUS transverse images, where the prostate is defined as the clinical target volume (CTV); the PTV includes the CTV plus treatment margins of 3–5 mm (depending on the patient’s pathology); and the OAR include the prostatic urethra and anterior rectal wall. For the prostate and PTV the dosimetric parameters analysed were the following: (1) the dose received by 90% of the relative volume (D90), (2) the relative volume to receive 100% of reference dose (V100), (3) the relative volume to receive 150% of the reference dose (V150) and (4) the relative volume to receive 200% of the reference dose (V200). These parameters offer both a good representation of the prostate and PTV coverage (via D90 and V100) and the incidence of ‘hot spots’ with V200 and V150. Based on recommendations for reporting from GEC-ESTRO the dosimetric parameters analysed for urethra were D10 and D30 while for rectum were the dose received by a volume of 2cc of the prostate (D2cc) and the dose received by a very small volume (D0.1cc) [ 8]. If fitted at any other time in the menstrual cycle, it will take 7 days to become effective for contraception, and the patient should use extra precautions (such as condoms) for those 7 days. If the patient is switching from another form of contraception, it may be effective immediately, depending on the type being switched from. O'Donnell JS, Teng MWL, Smyth MJ. Cancer immunoediting and resistance to T cell-based immunotherapy. Nat Rev Clin Oncol. 2019;16(3):151–67. Immediately after insertion, the presence of the implant should be verified by palpation . In case the implant cannot be palpated or when the presence of the implant is doubtful, see section 4.2 How to insert Nexplanon subsection 'If the implant is not palpable after insertion'. Exploratory surgery without knowledge of the exact location of the implant is strongly discouraged.

most appropriate MedDRA term (version 10.1) to describe a certain adverse reaction is listed. Synonyms or related conditions are not listed, but should be taken into account as well. Explain that the patient should always be able to feel the implant and they will be shown how to do this when it is fitted

you’ll need to keep the bandage clean and dry for 48 hours – cover it with plastic in the bath or shower If the implant is not inserted in accordance with the instructions and not on the correct day, this may result in an unintended pregnancy (see section 4.2 How to insert Nexplanon and When to insert Nexplanon). Limited epidemiological data do not suggest an increased risk of VTE or ATE in women using the implant; however, there have been postmarketing reports of VTE and ATE, in women using etonogestrel implants. It is recommended to assess risk factors, which are known to increase the risk of VTE and ATE. Stromberg J, Martinez A, Gonzales J. et al. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: Treatment description and preliminary results of a phase I/II clinical trial” Int J Radiat Oncol Biol Phys. 1995; 33:161. doi: 10.1016/0360-3016(95)00035-W. [ PubMed] [ CrossRef] [ Google Scholar]

Clinical data indicate that Nexplanon does not influence the production or the quality (protein, lactose or fat concentrations) of breast milk. However, small amounts of etonogestrel are excreted in breast milk. Based on an average daily milk ingestion of 150 ml/kg, the mean daily infant etonogestrel dose calculated after one month of etonogestrel release is approximately 27 ng/kg/day. This corresponds to approximately 2.2 % of the weight-adjusted maternal daily dose and to approximately 0.2 % of the estimated absolute maternal daily dose. Subsequently the milk etonogestrel concentration decreases with time during the lactation period. The results show that geographical misses and/or needle displacements during implant may have repercussions for centres without real-time live planning due to the resultant dose distribution from the misplaced seeds not being taken into account. A Surgeon will be able to control the depth, angulation and density of the implantation meticulously using an implanter pen. This also leads to natural results blending new transplanted grafts into existing hair. Increased Survival Rate of the Graft during Hair Transplantation