FDA Adverse Event Injury Summary report: N

MENTOR MEMORYGEL BREAST IMPLANT

MDR report key: 10103344 · Received May 29, 2020

Report

Report Number
1645337-2020-06677
Event Type
Injury
Date Received
May 29, 2020
Date of Event
January 1, 2020
Manufacturer
MENTOR TEXAS
Product Code
FTR
UDI-DI
00081317000310
PMA / PMN Number
P030053
Adverse Event
Yes
Report Source
Manufacturer report
Reporter Location
OK, US
Reporter Occupation
OTHER

Narratives

Additional Manufacturer Narrative · 0

A MANUFACTURING RECORD EVALUATION WAS PERFORMED FOR THE FINISHED DEVICE NUMBER 6974321, AND NO NON-CONFORMANCE'S WERE IDENTIFIED. MANUFACTURER¿S REFERENCE NUMBER: (B)(4).

Additional Manufacturer Narrative · 0

THE MENTOR FAILURE ANALYSIS LAB RECEIVED THE DEVICE FOR EVALUATION ON JULY 7, 2020. THE ANALYSIS HAS BEGUN BUT IS NOT COMPLETE AT THIS TIME. WHEN THE INVESTIGATION AND ANALYSIS HAVE BEEN COMPLETED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. MANUFACTURER¿S REFERENCE NUMBER: (B)(4).

Additional Manufacturer Narrative · 0

THE INVESTIGATION OF THE RETURNED DEVICE WAS COMPLETED BY THE FAILURE ANALYSIS LAB ON JULY 28, 2020. DEVICE EVALUATION SUMMARY: DURING THE VISUAL EVALUATION, NO APPARENT DAMAGE OR VISUAL ANOMALIES WERE OBSERVED ON THE RETURNED DEVICE. MENTOR CONCLUDED THAT THE CAPSULAR CONTRACTURE IN THE PATIENT´S BREAST WAS THE RESULT OF THE BODY´S INDIVIDUAL PHYSIOLOGICAL RESPONSE TO THE IMPLANTATION OF A FOREIGN OBJECT IN SOFT TISSUE. CAPSULAR CONTRACTURE IS A KNOWN COMPLICATION ASSOCIATED WITH THESE DEVICES AND IS REFERENCED IN OUR CURRENT PRODUCT INSERT DATA SHEET. THE AMERICAN SOCIETY OF PLASTIC SURGEONS RECOMMENDS AND ENCOURAGES MEMBER SURGEONS TO ALWAYS SUBMIT BREAST IMPLANTS, CAPSULE, AND EFFUSION TO PATHOLOGY FOR EXAMINATION. EACH DEVICE IS VISUALLY INSPECTED DURING MANUFACTURING TO ENSURE THE DEVICE MEETS THE REQUIRED SPECIFICATIONS PRIOR TO SHIPMENT. MANUFACTURER¿S REFERENCE NUMBER: (B)(4).

Additional Manufacturer Narrative · 0

ADDITIONAL INFORMATION WAS RECEIVED ON AUGUST 3, 2020. IN ADDITION TO THE ISSUES REPORTED PREVIOUSLY, THE FORMATION OF CYSTS WAS REVEALED THROUGH MAGNETIC RESONANCE IMAGING. THE FOLLOWING STATEMENT WAS ADDED TO THE DEVICE EVALUATION SUMMARY REPORTED PREVIOUSLY: A BREAST CYST IS A FLUID-FILLED SAC WITHIN THE BREAST. ONE BREAST CAN HAVE ONE OR MORE BREAST CYSTS. THEY ARE OFTEN DESCRIBED AS ROUND OR OVAL LUMPS WITH DISTINCT EDGES. BREAST CYSTS ARE USUALLY AND TYPICALLY DO NOT REQUIRE TREATMENT, BUT THEY CAN BE DRAINED USING FINE NEEDLE ASPIRATION IF THE CYST IS LARGE OR UNCOMFORTABLE. MANUFACTURER¿S REFERENCE NUMBER: (B)(4).

Additional Manufacturer Narrative · 1

SINCE THE DEVICE HAS NOT BEEN RETURNED FOR ANALYSIS, NO PRODUCT FAILURE ANALYSIS CAN BE CONDUCTED, AND NO DETERMINATION OF POSSIBLE CONTRIBUTING FACTORS CAN BE MADE. AS SUCH, THE INVESTIGATION WILL BE CLOSED. IF THE COMPLAINT DEVICE IS RECEIVED IN THE FUTURE, THE INVESTIGATION WILL BE REOPENED AND CONDUCTED AS APPROPRIATE. A MANUFACTURING RECORD EVALUATION IS IN PROGRESS. ONCE COMPLETED, A SUPPLEMENTAL REPORT WILL BE SUBMITTED. REASON FOR DEVICE EXPLANT AND/OR REOPERATION: CAPSULAR CONTRACTURE. MANUFACTURER¿S REFERENCE NUMBER: (B)(4).

Description of Event or Problem · 1

IT WAS REPORTED THAT A (B)(6) YEAR-OLD CAUCASIAN FEMALE WHO UNDERWENT PRIMARY BREAST AUGMENTATION WITH 375CC MENTOR MEMORYGEL BREAST IMPLANTS EXPERIENCED SILENT RIGHT SIDED RUPTURE AND BILATERAL CAPSULAR CONTRACTURE POST PROCEDURE. THE RIGHT SIDED CAPSULAR CONTRACTURE WAS BAKER GRADE IV. THE LEFT SIDED CAPSULAR CONTRACTURE WAS BAKER GRADE III. THE RUPTURE WAS DIAGNOSED THROUGH MAGNETIC RESONANCE IMAGING. AS A RESULT, THE PATIENT HAD BILATERAL PROSTHESIS REPLACEMENT WITH 450CC MENTOR MEMORYGEL BREAST IMPLANTS PERFORMED ON (B)(6) 2020. SEE 1645337-2020-06678 FOR CONTRALATERAL PROSTHESIS REPORT.

Devices

Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
566193 MENTOR MEMORYGEL BREAST IMPLANT PROSTHESIS, BREAST, NONINFLATABLE, INTERNAL, SILICONE GEL-FILLED FTR MENTOR TEXAS 3503751BC 6974321 00081317000310

Patients

Seq Age Sex Outcome Treatment
1 30 YR Required Intervention