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

Catalog Number	3341202
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Codes	Deformity/ Disfigurement (2360); Post Operative Wound Infection (2446); Wrinkling (2613)
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Since the device has not been returned for analysis, no product failure analysis can be conducted, and no determination of possible contributing factors can be made.As such, the investigation will be closed.If the complaint device is received in the future, the investigation will be reopened and conducted as appropriate.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.Reason for device explant and/or reoperation: wrinkling, asymmetry.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.Manufacturer¿s reference number: (b)(4).
Event or Problem Description
It was reported that a patient who underwent a breast reconstruction procedure with mentor memoryshape breast implant 390cc gel breast prostheses developed breast wrinkling and asymmetry in both breasts post implantation.As a result, the patient underwent bilateral explantation on an unknown date.This medwatch report is for the patient¿s left breast prosthesis.Refer to manufacturer report number 1645337-2024-06740 for the report for the patient¿s right breast prosthesis.
Additional Manufacturer Narrative
On 11-mar-2025, mentor received additional information about the event.It was reported that mri results indicated possible rupture of the right breast prosthesis.This medwatch report is for the patient¿s left breast prosthesis.Manufacturer¿s reference number: (b)(4).
Additional Manufacturer Narrative
On 13-aug-2025, mentor received additional information about the event.It was reported that the patient had presented with infection.Manufacturer¿s reference number: (b)(4).
Additional Manufacturer Narrative
On 02-sep-2025, mentor received additional information about the event.The patient had developed pain, swelling, and a seroma in her right breast.The previously reported infection was determined to be cellulitis and applicable to patient¿s right breast only.The patient required hospitalization.This medwatch report is for the patient's left breast prosthesis.Manufacturer¿s reference number: (b)(4).
Additional Manufacturer Narrative
On 09-oct-2025, mentor received additional information about the event.The patient underwent explantation on (b)(6) 2024.Manufacturer¿s reference number: (b)(4).

• 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: 21256615
• Report Number: 1645337-2025-00768
• Device Sequence Number: 21097329
• Product Code: FTR
• UDI-Device Identifier: 00081317005209
• UDI-Public: (01)00081317005209(17)220611(10)7475364
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: P060028
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2018
• Device Explanted Year: 2024
• Serviced by Third Party (Y/N): Unknown
• Reporter Type: Manufacturer
• Report Source: Study
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup,Followup,Followup,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: 06/11/2022
• Device Catalogue Number: 3341202
• Device Lot Number: 7475364
• Was Device Available for Evaluation?: No
• Is the Reporter a Health Professional?: No
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 01/10/2025
• Supplement Date Received by Manufacturer: 03/11/2025; 08/13/2025; 09/02/2025; 10/09/2025
• Initial Report FDA Received Date: 01/28/2025
• Supplement Report FDA Received Date: 04/01/2025; 08/27/2025; 09/19/2025; 10/29/2025
• Was Device Evaluated by Manufacturer? (Y/N): No
• Date Device Manufactured: 06/12/2017
• 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
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Sex: Female
• Patient Ethnicity: Non Hispanic
• Patient Race: White