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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: Allergan (Costa Rica) Style 68 Saline Filled Breast Implant; prosthesis, breast, inflatable, internal, saline

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Allergan (Costa Rica) Style 68 Saline Filled Breast Implant; prosthesis, breast, inflatable, internal, saline Back to Search Results
Catalog Number 68HP-350
Medical Device Problem Code Device Appears to Trigger Rejection (1524)
Health Effect - Clinical Code Capsular Contracture (1761)
Date of Event 06/23/2026
Type of Reportable Event Serious Injury
Event or Problem Description
Healthcare professional reported "scar tissue contracture, painful beaker iii/iv encapsulation, "hardening of the supralateral axillary region and thickening of the pectoralis mayor muscle with painful breast deformity", "double-bubble breast deformity", "decreased size" and "upper pole fullness".This record is for the right side.Device was explanted.
 
Additional Manufacturer Narrative
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/iv.
 
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Brand Name
Style 68 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 Key50101242
Report Number9617229-2026-14475
Device Sequence Number5279068
Product Code FWM
UDI-Device Identifier10888628000407
UDI-Public(01)10888628000407(17)100515
Combination Product (Y/N)N
Initial Reporter StateCA
Initial Reporter CountryUS
PMA/510(K) Number
P990074
Number of Events Summarized1
Summary Report (Y/N)N
Device Implanted Year2006
Device Explanted Year2026
Reporter Type Manufacturer
Report Source Health Professional
Initial Reporter Occupation Physician
Type of Report Initial,Followup
Report Date (Section B) 09/18/2026
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 Date05/15/2010
Device Catalogue Number68HP-350
Device Lot Number1288639
Was Device Available for Evaluation? Yes
Date Returned to Manufacturer09/03/2026
Is the Reporter a Health Professional? Yes
Initial Date Received by Manufacturer 07/07/2026
Supplement Date Received by Manufacturer09/03/2026
Initial Report FDA Received Date07/31/2026
Supplement Report FDA Received Date09/18/2026
Was Device Evaluated by Manufacturer? (Y/N) Yes
Date Device Manufactured06/20/2006
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 Number1
Outcome Attributed to Adverse Event Required Intervention;
Patient Age47 YR
Patient SexFemale
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