MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) STYLE 163 SALINE FILLED BREAST IMPLANT; PROSTHESIS, BREAST, INFLATABLE, INTERNAL, SALINE

Catalog Number	163-360
Medical Device Problem Code	Fluid/Blood Leak (1250)
Health Effect - Clinical Code	Failure of Implant (1924)
Date of Event	09/03/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
Clarification to d6a: implant date of (b)(6) 2002 provided.However, this has been removed from that field as the manufacture date of the device is 09/jan/2002.Continued e1 -- alternate phone numbers: (b)(6).A review of the device history record has been completed.No deviations or non-conformances noted.Further information from the reporter regarding event, product, or patient details has been/will be requested.No additional information is available at this time.Reason for reoperation: deflation.
Event or Problem Description
Healthcare professional reported ¿deflation¿.This record is for the right side.Device was explanted and replaced.
Additional Manufacturer Narrative
Device evaluation: per the analysis performed, the assessments of the complaints and any potential manufacturing issue are displayed along with any further actions required: ¿ deflation: not observed through leak test inspection.None of the other observations performed during the device analysis (broken of plug strap) are found to be potentially related to the manufacturing process, and, therefore, no further actions are required for these observations.Peer/ supervisor reviewer.
Event or Problem Description
Healthcare professional reported ¿deflation¿.This record is for the right side.Device was explanted and replaced.
Additional Manufacturer Narrative
Additional, changed, and/or corrected data: h3.
Event or Problem Description
Healthcare professional reported ¿deflation¿.This record is for the right side.Device was explanted and replaced.

• Brand Name: STYLE 163 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): SANTA BARBARA; 900 parkway global park zona f; zona franca; la aurora de heredia ; CS
• Manufacturer Contact: terry ingram ; 2525 dupont drive; irvine, CA 92612 ; 8479366324
• MDR Report Key: 23486158
• Report Number: 9617229-2025-19088
• Device Sequence Number: 18724629
• Product Code: FWM
• UDI-Device Identifier: 10888628000704
• UDI-Public: 10888628000704
• Combination Product (Y/N): N
• Initial Reporter State: UT
• Initial Reporter Country: US
• PMA/510(K) Number: P990074
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2002
• 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): 01/13/2026

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: 12/04/2005
• Device Catalogue Number: 163-360
• Device Lot Number: 570717
• 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: 10/16/2025
• Supplement Date Received by Manufacturer: 12/03/2025; 01/03/2026
• Initial Report FDA Received Date: 11/06/2025
• Supplement Report FDA Received Date: 12/22/2025; 01/13/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 01/09/2002
• 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: 62 YR
• Patient Sex: Female
• Patient Weight: 65 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White