MAUDE Adverse Event Report: ALLERGAN (COSTA RICA) Style 168 Saline Filled Breast Implant; prosthesis, breast, inflatable, internal, saline

Catalog Number	168-390
Medical Device Problem Code	Adverse Event Without Identified Device or Use Problem (2993)
Health Effect - Clinical Code	Appropriate Clinical Signs, Symptoms and Conditions Term/Code Not Available (4581)
Type of Reportable Event	Serious Injury
Event or Problem Description
Healthcare professional reported "textured to smooth".Later healthcare professional reported "fear alcl" and "rippling".This record is for left side.The device was explanted.
Additional Manufacturer Narrative
A review of the device history record has been completed.No deviations or non-conformances noted.The event of rippling 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: rippling.
Event or Problem Description
Healthcare professional reported "textured to smooth".Later healthcare professional reported "fear alcl" and "rippling".This record is for left side.The device was explanted.
Additional Manufacturer Narrative
Device evaluation: the device related to the reported event visibility/palpability was received on july 20,2026, with lot number 1363511.Per the investigation procedure, the device is analyzed through visual inspection microscopic inspection if openings are observed and a weight verification (if applicable).Per the analysis performed, the assessments of the complaints and any potential manufacturing issue are displayed along with any further actions required: visibility/palpability: unable to observe through visual inspection as it is a physiological phenomenon.None of the other observations performed during the device analysis (crease and broken in the plug strap) are found to be potentially related to the manufacturing process, and, therefore, no further actions are required for these observations.Additional, changed, and/or corrected data: d.9., h.2., h.3., h.6.

• Brand Name: Style 168 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 ; +1(847)936-6324
• MDR Report Key: 25630447
• Report Number: 9617229-2026-12252
• Device Sequence Number: 21280443
• Product Code: FWM
• UDI-Device Identifier: 10888628000841
• UDI-Public: (01)10888628000841(17)101017
• Combination Product (Y/N): N
• Initial Reporter State: CA
• Initial Reporter Country: US
• PMA/510(K) Number: P990074
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2007
• Device Explanted Year: 2026
• Reporter Type: Manufacturer
• Report Source: Health Professional
• Initial Reporter Occupation: Physician
• Type of Report: Initial,Followup
• Report Date (Section B): 08/24/2026

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?: No
• Operator of Device: Health Professional
• Device Expiration Date: 10/17/2010
• Device Catalogue Number: 168-390
• Device Lot Number: 1363511
• Was Device Available for Evaluation?: Yes
• Date Returned to Manufacturer: 07/20/2026
• Is the Reporter a Health Professional?: Yes
• Was the Report Sent to FDA?: No
• Type of Report(Section G): Thirty-Day
• Initial Date Received by Manufacturer: 05/14/2026
• Supplement Date Received by Manufacturer: Not provided
• Initial Report FDA Received Date: 06/25/2026
• Supplement Report FDA Received Date: 08/24/2026
• Was Device Evaluated by Manufacturer? (Y/N): Yes
• Date Device Manufactured: 11/22/2006
• 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: 49 YR
• Patient Sex: Female
• Patient Weight: 126 LB
• Patient Race: White