MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) INSPIRA SMOOTH SILICONE GEL FILLED BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Model Number	SRLP-540
Medical Device Problem Codes	Device Appears to Trigger Rejection (1524); Material Rupture (1546); Device Handling Problem (3265)
Health Effect - Clinical Codes	Capsular Contracture (1761); No Clinical Signs, Symptoms or Conditions (4582)
Type of Reportable Event	Serious Injury
Event or Problem Description
Healthcare professional reported right side capsular contracture, baker grade iv.Device remains implanted.
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.The event of capsular contracture is a physiological complication and analysis of the device generally does not assist allergan in determining a probable cause for this event.Further information from the reporter regarding event, product, or patient details has been requested.No additional information is available at this time.Reason for reoperation: capsular contracture baker grade iv.
Additional Manufacturer Narrative
Additional, changed, and/or corrected data: b5 g1 g2.
Event or Problem Description
Patient later reported "i had 3 surgeries "previous capsular contractures and the doctor never replaced, just kept replacing with the same implants" deemed by allergan medical safety as use error and "pain in breast".Patient later reported "malposition".
Event or Problem Description
Healthcare professional reported right side capsular contracture, baker grade iv.Patient later reported "i had 3 surgeries "previous capsular contractures and the doctor never replaced, just kept replacing with the same implants" and "pain in breast".Patient later reported "malposition".Patient later reported rupture.Healthcare professional later reported rupture.Device was explanted.
Additional Manufacturer Narrative
Device evaluation: based on the device analysis grid, the assessments of the complaint are: rupture: observed crease sharp on anterior assessed as fold flaw opening.Capsular contracture: unable to confirm as it is a medical event not related to the device.Malposition: unable to confirm as it is a medical event not related to the device.Use error: unable to confirm as it is a medical event not related to the device.Additional observations: crease fold observed.Stress marks observed.Wear abrasion observed.No further actions are required as no manufacturing issues are observed.Additional, changed, and/or corrected data: a2, b5, d9, e1, h3, h6.
Event or Problem Description
Healthcare professional reported right side capsular contracture baker grade iv.Patient later reported "i had 3 surgeries "previous capsular contractures and the doctor never replaced, just kept replacing with the same implants" and "pain in breast".Patient later reported "malposition".Patient later reported rupture.Healthcare professional later reported rupture.Patient undergone total capsulectomy.Device has been explanted and replaced.

• Brand Name: INSPIRA SMOOTH SILICONE GEL FILLED BREAST IMPLANT
• Common Device Name: PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED
• Manufacturer (Section D): ALLERGAN (COSTA RICA); 900 parkway global park; zona franca
• Manufacturer (Section G): ALLERGAN (COSTA RICA); 900 parkway global park; zona franca
• Manufacturer Contact: terry ingram ; 12331-a riata trace parkway; building 3; austin, TX 78727 ; 8479366324
• MDR Report Key: 14518066
• Report Number: 9617229-2022-08581
• Device Sequence Number: 6429021
• Product Code: FTR
• UDI-Device Identifier: 10888628006973
• UDI-Public: 10888628006973
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: P020056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Device Explanted Year: 2023
• Reporter Type: Manufacturer
• Report Source: Consumer,Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup
• Report Date (Section B): 11/10/2023

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: No
• Operator of Device: Health Professional
• Device Expiration Date: 07/18/2022
• Device Model Number: SRLP-540
• Device Catalogue Number: SRLP-540
• Device Lot Number: 3091981
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: 05/03/2022
• Supplement Date Received by Manufacturer: 07/06/2023; 09/11/2023; 10/18/2023
• Initial Report FDA Received Date: 05/26/2022
• Supplement Report FDA Received Date: 07/28/2023; 10/03/2023; 11/10/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 08/18/2017
• Is the Device Labeled for Single Use? (Y/N): Yes
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Usage of Device: Initial
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 34 YR
• Patient Sex: Female
• Patient Weight: 93 KG