MAUDE Adverse Event Report: MENTOR TEXAS MENTOR MEMORYGEL BREAST IMPLANT; PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED

Catalog Number	3507001BC
Medical Device Problem Code	Material Rupture (1546)
Health Effect - Clinical Code	No Code Available (3191)
Date of Event	04/09/2019
Type of Reportable Event	Serious Injury
Additional Manufacturer Narrative
The mentor failure analysis lab has received the device for evaluation.The analysis has begun but is not complete at this time.When the investigational analysis has been completed, a supplemental report will be submitted.A manufacturing record evaluation is in progress.Once completed, a supplemental report will be submitted.Reason for device explant and/or reoperation: material rupture.Manufacturer¿s reference number: (b)(4).
Event or Problem Description
It was reported that a (b)(6) female who underwent primary breast reconstruction with mentor siltex contour profile spectrum 650cc saline prosthesis experienced bilateral deflation post procedure.Right sided deflation was diagnosed through magnetic resonance imaging on (b)(6) 2019.Left sided deflation was discovered during the explant surgery on (b)(6) 2019.The devices were replaced with 755cc mentor memorygel breast implants.This report relates to the left prosthesis.See 1645337-2019-10887 for contralateral prosthesis report.
Additional Manufacturer Narrative
Additional information was received on 6/19/2019.The impacted product was a 700cc mentor memorygel breast implant, rather than the mentor siltex contour profile spectrum 650cc saline prosthesis reported initially.The device ruptured, rather than deflated.Section d has been updated with all available information.A manufacturing record evaluation was performed for the finished device 6009801 number, and no non-conformances related to the reported complaint condition were identified.The investigation of the returned device was completed by the failure analysis lab on 6/22/2019.Device evaluation summary: according with the information reported the patient experienced a rupture of the breast implant.During analysis of the sample, two tears were observed at the union between patch and shell of the implant.Microscopic examination was performed and no evidence of instrument damage was observed.No other anomalies were observed.Causes of rupture of gel-filled implants include, but are not limited to, the following events: damage from surgical instruments, intraoperative or postoperative trauma, excessive stresses or manipulations as may occur during normal daily routines including customary and purposeful trauma to the breast.Rupture is a known complication associated with these devices and is referenced in our product insert data sheet.It should be noted that as part of our quality process, each device is visually inspected during manufacturing to ensure the device meets the required specifications prior to shipment.Based on the information reported and/or the product investigation, there is no evidence that the issue is related with the manufacturing process.Manufacturer¿s reference number: (b)(4).

• Brand Name: MENTOR MEMORYGEL BREAST IMPLANT
• Common Device Name: PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED
• Manufacturer (Section D): MENTOR TEXAS; 3041 skyway circle north; irving TX 75038
• MDR Report Key: 8570830
• Report Number: 1645337-2019-10886
• Device Sequence Number: 2572683
• Product Code: FTR
• UDI-Device Identifier: 00081317002178
• UDI-Public: 00081317002178
• Combination Product (Y/N): N
• Initial Reporter State: MA
• Initial Reporter Country: US
• PMA/510(K) Number: P030053
• Number of Events Summarized: 1
• Summary Report (Y/N): N
• Device Implanted Year: 2010
• Device Explanted Year: 2019
• Reporter Type: Manufacturer
• Report Source: health professional
• Initial Reporter Occupation: Other
• Type of Report: Initial,Followup
• Report Date (Section B): 04/09/2019

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: 07/31/2015
• Device Catalogue Number: 3507001BC
• Device Lot Number: 6009801
• Was Device Available for Evaluation?: Device Returned to Manufacturer
• Date Returned to Manufacturer: 04/30/2019
• Initial Date Received by Manufacturer: 04/09/2019
• Supplement Date Received by Manufacturer: 06/19/2019
• Initial Report FDA Received Date: 05/01/2019
• Supplement Report FDA Received Date: 06/25/2019
• Is This a Single-Use Device that was Reprocessed and Reused on a Patient? (Y/N): No
• Patient Sequence Number: 1
• Outcome Attributed to Adverse Event: Required Intervention
• Patient Age: 54 YR