MAUDE Adverse Event Report: MENTOR TEXAS MENTOR MEMORYSHAPE BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Catalog Number	3341402
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Capsular Contracture (1761); Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Date of Event	03/03/2023
Type of Reportable Event	Serious Injury
Event or Problem Description
It was reported that a patient underwent a breast reconstruction revision surgery with implantation of a 620cc mentor memoryshape breast implant prosthesis.Post-operatively, the patient was bit by a spider which caused cellulitis of the right nipple.Afterwards, magnetic resonance imaging was performed which indicated a ruptured right breast implant and a prominent right axillary lymph node.A skin biopsy of the right breast was also performed which indicated free silicone.During a consultation with a medical professional, the patient reported left breast pain, not feeling well, vision changes, difficulty swallowing, cough, abdominal pain, vomiting, change in appetite, dizziness, frequent headaches and migraines.Subsequently, she was diagnosed with bilateral baker grade iv capsular contracture.As a result, the patient underwent bilateral removal and replacement with 685cc mentor memorygel boost breast implants on (b)(6) 2023.However, the removed implants were reported to intact.This report is for the left breast prosthesis.Refer to manufacturing report number 1645337-2023-12839 for the contralateral event.
Additional Manufacturer Narrative
The mentor failure analysis lab has received the device for evaluation.The analysis has begun but is not complete at this time.  when the investigational analysis has been completed, a supplemental report will be submitted.A manufacturing record evaluation (mre) was performed, and no anomalies were found related to this complaint.In addition, the mre verifies that the device was manufactured in accordance with documented specification and procedures.Mentor is submitting this report pursuant to the provisions of 21 cfr, part 803.  this report may be based on information which mentor has not been able to investigate or verify prior to the required reporting date.  this report does not reflect a conclusion by fda, mentor, or its employees that the report constitutes an admission that the device, mentor, or its employees caused or contributed to the potential event described in this report.  if certain information is unknown, not available or does not apply, the section/field of the form is left blank.Reason for device explant and/or reoperation: capsular contracture, generalized illness.H6 health effect - clinical code e2402: generalized illness.Manufacturer¿s reference number: (b)(4).
Additional Manufacturer Narrative
On october 31, 2023, mentor completed an evaluation on the returned device.Mentor conducted a visual inspection and leak testing of the device.During visual evaluation, no apparent damage or visual anomalies were observed on the breast implant device.Leak testing was performed, in accordance with mentor procedures, and no leak sites or gel exposures were detected during the analysis.Mentor concluded that the capsular contracture in the patient´s breast was the result of the body´s individual physiological response to the implantation of a foreign object in soft tissue.Capsular contracture is a known complication associated with these devices and is referenced in our current product insert data sheet.The american society of plastic surgeons recommends and encourages member surgeons to always submit breast implants, capsule, and effusion to pathology for examination.At the present time, there is no sufficient evidence to show an association between breast implants and generalized illness (assessing the risks of breast implants and fda¿s vision for the national breast implant registry).On november 06, 2023, mentor became aware that information was inadvertently omitted from the initial report.As the device was received, the following information should have been included.H6.Type of investigation: testing of actual/suspected device (b01); h6.Investigation findings: results pending completion of investigation (c21); h6.Investigation conclusions: conclusion not yet available (d16).Manufacturer¿s reference number: (b)(4) in the initial, h6.Type of investigation, h6.Investigation findings, h6.Investigation conclusions should have include testing of actual/suspected device (b01), results pending completion of investigation (c21), and conclusion not yet available (d16), respectively, as the device was received for analysis.

• Brand Name: MENTOR MEMORYSHAPE BREAST IMPLANT
• Common Device Name: PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED
• Manufacturer (Section D): MENTOR TEXAS; 3041 skyway circle north; irving TX 75038
• Manufacturer (Section G): MENTOR TEXAS; 3041 skyway circle north; irving TX 75038
• Manufacturer Contact: kate karberg ; 3041 skyway circle north; irving, TX 75038 ; 3035526892
• MDR Report Key: 18035860
• Report Number: 1645337-2023-12838
• Device Sequence Number: 20638499
• Product Code: FTR
• UDI-Device Identifier: 00081317005247
• UDI-Public: 00081317005247
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: P060028
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2016
• Device Explanted Year: 2023
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Company Representative
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup

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: 05/25/2021
• Device Catalogue Number: 3341402
• Device Lot Number: 7333671
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 10/19/2023
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Initial
• Initial Date Received by Manufacturer: Not provided
• Supplement Date Received by Manufacturer: 10/31/2023
• Initial Report FDA Received Date: 10/30/2023
• Supplement Report FDA Received Date: 11/06/2023
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 05/21/2016
• 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: 67 YR
• Patient Sex: Female