How is breast capsular contraction diagnosed?

Diagnosis of Breast Capsular Contracture

Breast capsular contracture is primarily diagnosed through clinical examination using the Baker classification system, with imaging modalities such as ultrasound and MRI serving as objective confirmatory tools when clinical assessment is unclear. 1, 2

Clinical Diagnosis: Baker Classification System

• Baker Grade I: Breast is soft and appears natural; implant is not palpable 1
• Baker Grade II: Breast is slightly firm but appears normal; implant can be palpated but is not visible 1
• Baker Grade III: Breast is firm and appears abnormal; implant is easily palpable and visible 1
• Baker Grade IV: Breast is hard, painful, cold, and appears abnormal; significant distortion is present 1

Clinical Examination Findings

• An implant that becomes more rounded in appearance may signify the presence of capsular contracture 3
• Clinical examination alone can be unreliable and subjective, necessitating additional objective measures 3, 1
• Palpation of the breast to assess firmness, tenderness, and implant mobility is essential 4
• Visual assessment for breast shape distortion, asymmetry, or abnormal contour 1

Imaging Modalities

Ultrasound

• Measures capsular thickness, which correlates significantly with Baker clinical grades 2
  • Baker I: Mean capsule thickness of 0.6 ± 0.2 mm
  • Baker II: Mean capsule thickness of 1.0 ± 0.53 mm
  • Baker III: Mean capsule thickness of 1.68 ± 0.99 mm
  • Baker IV: Mean capsule thickness of 1.52 ± 0.46 mm 2
• Can detect implant shell deformity and abnormal wrinkles which are five times more likely in Baker III and IV contractures 2
• Non-invasive, cost-effective, and readily available option 1

MRI

• Provides detailed visualization of capsular thickness
  • Baker I-II: Mean capsule thickness of 1.39 mm
  • Baker III-IV: Mean capsule thickness of 2.62 mm 1
• Offers superior soft tissue contrast for evaluating capsular thickening 1
• Can differentiate between capsular contracture and other complications such as implant rupture 3

Diagnostic Algorithm

1. Begin with clinical assessment using Baker classification system 1
2. For equivocal cases or Baker grades II-IV, proceed with imaging:
   • First-line: Ultrasound to measure capsular thickness and assess implant deformity 2
   • Second-line: MRI for more detailed evaluation when ultrasound results are inconclusive 1
3. Consider previous history of radiation therapy, as this significantly increases risk of capsular contracture 5

Common Pitfalls and Caveats

• Clinical examination alone may be subjective and inconsistent between examiners 1, 2
• Capsular calcifications correlate with implant age but do not necessarily indicate contracture 3
• Do not confuse normal postoperative firmness with early capsular contracture 4
• Differentiate between capsular contracture and other complications such as implant rupture, which may present with similar symptoms 3
• Previous history of silicone implants may affect imaging interpretation; comparison with prior studies is critical 3