MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) STYLE 468 SALINE FILLED BREAST IMPLANT; PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE

Catalog Number	468-230
Medical Device Problem Code	Device Appears to Trigger Rejection (1524)
Health Effect - Clinical Code	Capsular Contracture (1761)
Date of Event	06/29/2022
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
This is a follow up to emdr 9617229-2022-12415.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 iii a review of the device history record has been completed.No deviations or non-conformances noted.
Event or Problem Description
Healthcare professional report a right side capsular contracture baker grade iii and an implant removal from textured to smooth due to the concerns of the product.Later healthcare professional reported "biocell".Device was explanted and replaced.
Additional Manufacturer Narrative
Device evaluation: based on the device analysis grid, the assessments of the complaint are: ¿ capsular contracture : unable to observe as it is not related to the manufacturing process.¿ anxiety - product/ procedure : unable to observe as it is not related to the manufacturing process.As per the investigation procedure, crease and opening were observed and none of the observations are found to be potentially related to the manufacturing process, no further actions are required.Additional, changed, and/or corrected data: d9, g1, h3, h6.
Event or Problem Description
Healthcare professional report a right side capsular contracture baker grade iii and an implant removal from textured to smooth due to the concerns of the product.Later healthcare professional reported "biocell".Device was explanted and replaced.
Event or Problem Description
Healthcare professional report a right side capsular contracture baker grade iii and an implant removal from textured to smooth due to the concerns of the product.Later healthcare professional reported "biocell".Device was explanted and replaced.
Additional Manufacturer Narrative
Corrected data: g.3.Aware date in previous medwatch should have been listed as (b)(6) 2025.

• Brand Name: STYLE 468 SALINE FILLED BREAST IMPLANT
• Common Device Name: PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE
• 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: 23158353
• Report Number: 9617229-2025-16378
• Device Sequence Number: 10145591
• Product Code: FWM
• UDI-Device Identifier: 10888628001091
• UDI-Public: 10888628001091
• Combination Product (Y/N): N
• Initial Reporter State: NJ
• Initial Reporter Country: US
• PMA/510(K) Number: P990074
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 1999
• Device Explanted Year: 2025
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 11/06/2025

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 04/19/2002
• Device Catalogue Number: 468-230
• Device Lot Number: 535557
• 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: 06/29/2022
• Supplement Date Received by Manufacturer: 10/01/2025; 10/23/2025
• Initial Report FDA Received Date: 09/26/2025
• Supplement Report FDA Received Date: 10/01/2025; 11/06/2025
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 06/01/1998
• 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: 46 YR
• Patient Sex: Female
• Patient Weight: 70 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White