MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) STYLE 20 SILICONE GEL FILLED BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Catalog Number	20-600
Medical Device Problem Codes	Device Appears to Trigger Rejection (1524); Material Rupture (1546)
Health Effect - Clinical Code	Capsular Contracture (1761)
Date of Event	11/20/2025
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.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: rupture, capsular contracture baker grade iii.
Event or Problem Description
Patient reported "rupture", "pain", "capsular contracture baker grade iii".Patient also reported "auto immune symptoms", "hair falling out" and "toxicity symptoms" that are not device related.Motrin 600 mg was prescribed.This record is for the right side.The device remains implanted.
Event or Problem Description
Patient reported "rupture", "pain", "capsular contracture baker grade iii".Patient also reported "auto immune symptoms", "hair falling out" and "toxicity symptoms" that are not device related.Later healthcare professional reported "capsular contracture baker grade iii" and "implant appears grossly intact", rupture has been removed.Motrin 600 mg was prescribed.This record is for the right side.The device remains implanted.
Additional Manufacturer Narrative
The event of rupture is no longer reportable.Information received stated the device was grossly intact.
Additional Manufacturer Narrative
Additional, changed, and/or corrected data: b3, b5, d6b, h6.
Event or Problem Description
Device has been explanted and replaced.

• Brand Name: STYLE 20 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: 23843099
• Report Number: 9617229-2025-22151
• Device Sequence Number: 21339663
• Product Code: FTR
• UDI-Device Identifier: 10888628001763
• UDI-Public: (01)10888628001763(10)2672668(11)141112(17)191012
• Combination Product (Y/N): N
• Initial Reporter Country: US
• PMA/510(K) Number: P020056
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2015
• Device Explanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Consumer
• Initial Reporter Occupation: Non-Healthcare Professional
• Type of Report: Initial,Followup,Followup
• Report Date (Section B): 03/16/2026

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: 10/12/2019
• Device Catalogue Number: 20-600
• Device Lot Number: 2672668
• Was Device Available for Evaluation?: No
• Type of Report(Section G): Follow-Up
• Initial Date Received by Manufacturer: 12/02/2025
• Supplement Date Received by Manufacturer: 01/16/2026; 02/23/2026
• Initial Report FDA Received Date: 12/18/2025
• Supplement Report FDA Received Date: 01/28/2026; 03/16/2026
• Date Device Manufactured: 11/12/2014
• 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: 43 YR
• Patient Sex: Female
• Patient Weight: 58 KG
• Patient Ethnicity: Non Hispanic
• Patient Race: White