To file a claim for any warranty, program the customer or surgeon should contact the local representative or Establishment Labs Customer Service Department at firstname.lastname@example.org for instructions on providing the necessary information and support documentation BEFORE any implant is explanted.
The following information is required to verify eligibility for financial assistance and/or product
replacement under the Extended Warranty Program:
Information to document the patient’s implant information and the patient’s event
description FOR302 – Complaint Notification (Customer) This document must be
completed and signed by the treating surgeon. This report includes vital information
that must be accurately stated, such as the device reference, series and lot numbers,
volume, base, projection, expiration date and type. It also must contain a detailed
description of the event being reported.
A copy of the operative report for the revision surgery
Copies of bills showing operating room, anesthesia, and surgeon fees incurred for the
For capsular contracture Baker grades III and IV claims: an ultrasound with the
correspondent technician report or an MRI scan and photographs of the patient as clinical
evidence; and the doctor’s report on the case showing the appearance of the breast prior
to the explant procedure.
For rupture claims: the explanted product is required; exceptionally when local applicable
laws do not allow it please contact Establishment Labs for assistance. When local
applicable laws allow it the patient must require for the surgeon to send the removed and
decontaminated product following the Explanted Breast Implants Handling Protocol (SID-
129), to Other topics.