MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) STYLE 115 SILICONE GEL FILLED BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Catalog Number	115-272
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	Failure of Implant (1924)
Date of Event	08/10/2025
Type of Reportable Event	Serious Injury
Event or Problem Description
Patient reported "rupture".This record is for the right side.Device remains implanted.
Additional Manufacturer Narrative
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
Patient reported "rupture".Later healthcare professional reported "patient visited the emergency room of the hospital after being injured while tripping over a stone on the beach", "damage to the right prosthesis inserted for breast surgery was performed on the chest ct performed at the hospital".This record is for the right side.Device was explanted and replaced with a non-abbvie brand and it will be returned.
Additional Manufacturer Narrative
Additional, changed, and/or corrected data: b3, d.9, h.3, h.6.Device evaluation: 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.No further actions are required as it is not related to the manufacturing process.No additional observations performed on the device.No further actions are required.
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.
Event or Problem Description
Patient reported "rupture".Later healthcare professional reported "patient visited the emergency room of the hospital after being injured while tripping over a stone on the beach", "damage to the right prosthesis inserted for breast surgery was performed on the chest ct performed at the hospital".This record is for the right side.Device was explanted and replaced with a non-abbvie brand and it will be return.

• Brand Name: STYLE 115 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: 22910995
• Report Number: 9617229-2025-14694
• Device Sequence Number: 9047932
• Product Code: FTR
• UDI-Device Identifier: 10888628002364
• UDI-Public: (01)10888628002364(10)2763012(11)150626(17)200526
• Combination Product (Y/N): N
• Initial Reporter Country: KS
• PMA/510(K) Number: P020056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2015
• Device Explanted Year: 2025
• Reporter Type: Manufacturer
• Report Source: Foreign,Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 12/05/2025

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: 05/26/2020
• Device Catalogue Number: 115-272
• Device Lot Number: 2763012
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 08/12/2025
• Supplement Date Received by Manufacturer: 09/29/2025; 11/13/2025
• Initial Report FDA Received Date: 08/28/2025
• Supplement Report FDA Received Date: 10/21/2025; 12/05/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/26/2015
• 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: 33 YR
• Patient Sex: Female
• Patient Race: Asian