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U.S. Department of Health and Human Services

MAUDE Adverse Event Report: MENTOR WORLDWIDE LLC BREAST IMPLANT

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MENTOR WORLDWIDE LLC BREAST IMPLANT Back to Search Results
Catalog Number 350-7300BC
Device Problem Material Rupture
Event Date 01/17/2017
Event Type  Injury  
Manufacturer Narrative

No device was received for analysis at the time of submission of the initial 3500a. Since the product was not returned for analysis, no product failure analysis can be conducted and no determination of possible contributing factors could be made. (b)(4).

 
Event Description

It was reported that a (b)(6) female patient with history of breast prosthesis implantations was diagnosed with left breast cancer. The patient was implanted with mentor smooth round gel mammary prostheses on (b)(6) 2005. (catalog # 350-7300bc, serial number left side (b)(4) and serial number right side (b)(4)). The patient had a mammogram done on 10/20/2015 that showed ¿some micro calcifications in the left superior breast¿ and recommended patient attempt to obtain prior mammogram images for comparison and for additional imaging (spot magnification views) to evaluate the micro calcifications. They also recommended ultrasound at the discretion of the radiologist. Conclusion on calcifications was bi-rads category: 0- incomplete: needs additional imaging evaluation. Additional mammograms were done on (b)(6) 2016 and (b)(6) 2017. A bilateral breast mri was done on (b)(6) 2017 due to recent diagnosis of left breast cancer (exact date of diagnosis is unknown) the mri was done to assess extent of disease and for possible contralateral disease. Mri confirmed that bilateral implants were ruptured. Mri report ((b)(6) 2017) cites patient had augmentation revision procedure in 2008 (no further information stated; no information on types or brand of implants used). The patient has no family or personal history of breast cancer before this diagnosis. Patient advised that she had not selected an explant surgeon or explant surgery date as of yet. Mentor made a decision to file a fda medwatch report based on the above information; however, currently, there is no solid evidence in the literature to suggest that breast implant rupture alter the risk of breast malignancies.

 
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Type of DeviceBREAST IMPLANT
Manufacturer (Section D)
MENTOR WORLDWIDE LLC
3041 skyway circle
north irving TX 75038 3540
Manufacturer (Section G)
MENTOR WORLDWIDE LLC
3041 skyway circle
north irving TX 75038 3540
Manufacturer Contact
joaquin kurz
north irving , TX 75038-3540
9497893837
MDR Report Key6378474
Report Number1645337-2017-00013
Device Sequence Number1
Product CodeFTR
Report Source Manufacturer
Source Type CONSUMER,HEALTH PROFESSIONAL
Reporter Occupation HEALTH PROFESSIONAL
Type of Report Initial
Report Date 02/03/2017
1 Device Was Involved in the Event
1 Patient Was Involved in the Event
Date FDA Received03/03/2017
Is This An Adverse Event Report? Yes
Is This A Product Problem Report? Yes
Device Operator HEALTH PROFESSIONAL
Device Catalogue Number350-7300BC
Device LOT Number5566433
OTHER Device ID Number350-7300BC
Was Device Available For Evaluation? No Answer Provided
Is The Reporter A Health Professional? Yes
Was the Report Sent to FDA?
Event Location No Information
Was Device Evaluated By Manufacturer? Device Not Returned To Manufacturer
Is The Device Single Use? No
Is this a Reprocessed and Reused Single-Use Device? No
Type of Device Usage

Patient TREATMENT DATA
Date Received: 03/03/2017 Patient Sequence Number: 1
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