MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) STYLE 120 SILICONE GEL FILLED BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Catalog Number	120-500
Medical Device Problem Codes	Device Appears to Trigger Rejection (1524); Material Rupture (1546)
Health Effect - Clinical Codes	Capsular Contracture (1761); Failure of Implant (1924)
Date of Event	07/10/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Continued e1.Email: info@perimeterplasticsurgery.Com.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: rupture.
Event or Problem Description
Healthcare professional reported "rupture via mri and implant exchange from textured to smooth".This record is for the right side.Device remains implanted.
Event or Problem Description
Device has been explanted and replaced.
Additional Manufacturer Narrative
Additional, changed, and/or corrected data: b5, d6b, h6.
Additional Manufacturer Narrative
Lab analysis: per the investigation procedure, the device is analyzed through visual inspection microscopic inspection if openings are observed and a weight verification.Per the analysis performed, the assessments of the complaints and any potential manufacturing issue are displayed along with any further actions required: ¿ anxiety-product/procedure: unable to observe through visual inspection as it is a physiological phenomenon.None of the other observations performed during the device analysis creases, wear abrasion and deformation are found to be potentially related to the manufacturing process, and, therefore, no further actions are required for these observations.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.A review of the device history record has been initiated.If any new, changed or corrected information is noted, a supplemental medwatch will be submitted.
Event or Problem Description
Healthcare professional reported "having pain on right side with possible capsular contracture grade unknown".
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.The device related to the reported events of rupture and anxiety - product/ procedure was received on (b)(6) 2025, with lot number 2750519.Per the investigation procedure, the device is analyzed through visual inspection microscopic inspection if openings are observed and a weight verification.Per the analysis performed, the assessments of the complaints and any potential manufacturing issue are displayed along with any further actions required: ¿ rupture: observed broken device through microscopic inspection assessed as unidentified (tear) opening and missing piece of shell assessed as inconclusive.No further actions are required as it is not related to the manufacturing process.¿ anxiety-product/procedure: unable to observe through visual inspection as it is a physiological phenomenon.No additional observations performed on the device.No further actions are required.Additional, changed, and/or corrected data: h.11.
Event or Problem Description
Healthcare professional reported "rupture via mri and implant exchange from textured to smooth".This record is for the right side.Device has been returned.
Additional Manufacturer Narrative
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.Reason for reoperation: capsular contracture, baker grade unknown.Device evaluation: the device related to the reported events of rupture and anxiety - product/ procedure was received on november 06, 2025, with lot number 2750519.Per the investigation procedure, the device is analyzed through visual inspection microscopic inspection if openings are observed and a weight verification.Per the analysis performed, the assessments of the complaints and any potential manufacturing issue are displayed along with any further actions required: ¿ rupture: observed broken device through microscopic inspection assessed as unidentified (tear) opening and missing piece of shell assessed as inconclusive.No further actions are required as it is not related to the manufacturing process.¿ capsular contracture: unable to observe through visual inspection as it is a physiological phenomenon.No additional observations performed on the device.No further actions are required.
Event or Problem Description
Healthcare professional reported "rupture via mri and implant exchange from textured to smooth".Healthcare professional later reported capsular contracture, baker grade unknown.This record is for the right side.Device has been returned.
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.
Event or Problem Description
Healthcare professional reported "rupture via mri and implant exchange from textured to smooth".Device was explanted and replaced.This record is for the right side.Device has been returned.

• Brand Name: STYLE 120 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; la aurora de heredia ; CS
• Manufacturer (Section G): ALLERGAN (COSTA RICA); 900 parkway global park; zona franca; la aurora de heredia ; CS
• Manufacturer Contact: terry ingram ; 2525 dupont drive; irvine, CA 92612 ; 8479366324
• MDR Report Key: 22742982
• Report Number: 9617229-2025-13389
• Device Sequence Number: 20937327
• Product Code: FTR
• UDI-Device Identifier: 10888628002579
• UDI-Public: (01)10888628002579(10)2750519(11)150606(17)200506
• Combination Product (Y/N): N
• Initial Reporter State: GA
• Initial Reporter Country: US
• PMA/510(K) Number: P020056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2017
• Device Explanted Year: 2025
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup,Followup,Followup
• Report Date (Section B): 03/10/2026

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?: Yes
• Operator of Device: Health Professional
• Device Expiration Date: 05/06/2020
• Device Catalogue Number: 120-500
• Device Lot Number: 2750519
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Is the Reporter a Health Professional?: Yes
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 07/18/2025
• Supplement Date Received by Manufacturer: 09/12/2025; 09/29/2025; 11/27/2025; 12/18/2025; 02/19/2026
• Initial Report FDA Received Date: 08/07/2025
• Supplement Report FDA Received Date: 09/29/2025; 12/02/2025; 12/15/2025; 01/12/2026; 03/10/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/06/2015
• 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: 35 YR
• Patient Sex: Female
• Patient Weight: 54 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: Asian