Skip to main content

The Value of Capsule Thickness on Breast Ultrasound as an Indicator of the Severity of Capsular Contracture and Its Correlation with the Baker Classification

Aesthetic Plastic Surgery volume 46, pages 621–629 (2022)Cite this article

Abstract

Background

We conducted this study to explore the value of the capsule thickness as an indicator of the severity of capsular contracture (CC) alternatively to the Baker classification system in patients who were treated with an implant-based augmentation mammaplasty.

Methods

A total of 117 eligible patients (202 breasts) were included in the current study. We measured the capsule thickness using ultrasound and histologic examination in association with the Baker grades I, II, III and IV. Then, we analysed agreement of the capsule thickness between the two methods using an intra-correlation coefficient (ICC 2,1) with 95% confidence intervals (CIs). The CC of Baker grades II, III and IV (105 breasts), for which the capsule thickness could be measured using US, served as Model 1. Moreover, Model 1 including the CC of Baker grades I (97 breasts) served as Model 2.

Results

The capsule thickness was measured as 0.58 ± 0.11 (0.4–0.8) mm, 1.07 ± 0.16 (0.8–1.31) mm and 1.89 ± 0.55 (1–4.1) mm on ultrasound in association with Baker grades II, III and IV, respectively. In addition, it was also measured as 0.28 ± 0.07 (0.09–0.41) mm, 0.58 ± 0.08 (0.42–0.75) mm, 1.06 ± 0.14 (0.79–1.34) mm and 2.13 ± 1.14 (1.38–6.98) mm on histologic examination in association with Baker grades I, II, III and IV, respectively. In Model 1 and 2, the ICC was calculated as 0.942 (95%CI 0.914–0.961) and 0.955 (95%CI 0.940–0.966), respectively. The cut-off values between the Baker grades I–II, II–III and III–IV were calculated as 0. mm, 0.8 mm and 1.2 mm, respectively.

Conclusions

In conclusion, the capsule thickness might be used as an indicator of the severity of CC alternatively to the Baker classification system. But further studies are warranted to establish our results.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. O’Shaughnessy K (2015) Evolution and update on current devices for prosthetic breast reconstruction. Gland Surg 4(2):97–110

    PubMed  PubMed Central  Google Scholar 

  2. American Society of Plastic Surgeons. The 2019 Plastic Surgery Report. https://www.plasticsurgery.org/documents/News/Statistics/2019/plastic-surgery-statistics-full-report-2019.pdf. Accessed Jan 1 2021

  3. Handel N, Cordray T, Gutierrez J, Jensen JA (2006) A long-term study of outcomes, complications, and patient satisfaction with breast implants. Plast Reconstr Surg 117(3):757–767 (discussion 768–772)

  4. Headon H, Kasem A, Mokbel K (2015) Capsular contracture after breast augmentation: an update for clinical practice. Arch Plast Surg 42(5):532–543

    Article  Google Scholar 

  5. Venkataraman S, Hines N, Slanetz PJ (2011) Challenges in mammography: part 2, multimodality review of breast augmentation–imaging findings and complications. AJR Am J Roentgenol 197(6):W1031–W1045

    Article  Google Scholar 

  6. Gylbert L, Berggren A (1989) Constant compression caliper for objective measurement of breast capsular contracture. Scand J Plast Reconstr Surg Hand Surg 23(2):137–142

    CAS  PubMed  Google Scholar 

  7. Prantl L, Englbrecht MA, Schoeneich M, Kuehlmann B, Jung EM, Kubale R (2014) Semiquantitative measurements of capsular contracture with elastography–first results in correlation to Baker Score. Clin Hemorheol Microcirc 58(4):521–528

    CAS  Article  Google Scholar 

  8. Song KY, Sung JY, Choi WS, Lim HG, Kim JH (2021) An ultrasound-assisted approach to an early detection of complications of an implant-based augmentation mammaplasty using the BellaGel® SmoothFine: preliminary 3-year clinical experience. J Surg Open Access 7(2):1–12. https://doi.org/10.16966/2470-0991.232

    Article  Google Scholar 

  9. Zahavi A, Sklair ML, Ad-El DD (2006) Capsular contracture of the breast: working towards a better classification using clinical and radiologic assessment. Ann Plast Surg 57(3):248–251

    CAS  Article  Google Scholar 

  10. Rzymski P, Kubasik M, Opala T (2011) Use of shear wave sonoelastography in capsular contracture before and after secondary surgery: report of two cases. J Plast Reconstr Aesthet Surg 64(12):e309–e312

    CAS  Article  Google Scholar 

  11. Siggelkow W, Faridi A, Spiritus K, Klinge U, Rath W, Klosterhalfen B (2003) Histological analysis of silicone breast implant capsules and correlation with capsular contracture. Biomaterials 24(6):1101–1109

    CAS  Article  Google Scholar 

  12. Juanpere S, Perez E, Huc O, Motos N, Pont J, Pedraza S (2011) Imaging of breast implants-a pictorial review. Insights Imaging 2(6):653–670

    Article  Google Scholar 

  13. Sowa Y, Yokota I, Itsukage S, Nakatsukasa K, Sakaguchi K, Taguchi T, Numajiri T (2017) Evaluation of the severity of capsular contracture using elastography after breast implant reconstruction. Clin Hemorheol Microcirc 66(1):1–6

    CAS  Article  Google Scholar 

  14. Hall-Findlay EJ (2020) Discussion: the baker classification for capsular contracture in breast implant surgery is unreliable as a diagnostic tool. Plast Reconstr Surg 146(5):963

    CAS  Article  Google Scholar 

  15. Park AY, Seo BK, Cho KR, Woo OH (2016) The utility of MicroPureTM ultrasound technique in assessing grouped microcalcifications without a mass on mammography. J Breast Cancer 19(1):83–86

    CAS  Article  Google Scholar 

  16. Chang EI, Hammond DC (2018) Clinical results on innovation in breast implant design. Plast Reconstr Surg 142(4S the science of breast implants): 31S-38S

  17. Valencia-Lazcano AA, Alonso-Rasgado T, Bayat A (2013) Characterisation of breast implant surfaces and correlation with fibroblast adhesion. J Mech Behav Biomed Mater 21:133–148

    CAS  Article  Google Scholar 

  18. Bachour Y, Bargon CA, de Blok CJM, Ket JCF, Ritt MJPF, Niessen FB (2018) Risk factors for developing capsular contracture in women after breast implant surgery: a systematic review of the literature. J Plast Reconstr Aesthet Surg 71(9):e29–e48

    Article  Google Scholar 

  19. de Bakker E, Rots M, Buncamper ME, Niessen FB, Smit JM, Winters HAH, Özer M, de Vet HCW, Mullender MG (2020) The baker classification for capsular contracture in breast implant surgery is unreliable as a diagnostic tool. Plast Reconstr Surg 146(5):956–962

    Article  Google Scholar 

  20. Scuderi N, Mazzocchi M, Fioramonti P, Bistoni G (2006) The effects of zafirlukast on capsular contracture: preliminary report. Aesthetic Plast Surg 30(5):513–520

    Article  Google Scholar 

  21. Rieger UM, Mesina J, Kalbermatten DF, Haug M, Frey HP, Pico R, Frei R, Pierer G, Lüscher NJ, Trampuz A (2013) Bacterial biofilms and capsular contracture in patients with breast implants. Br J Surg 100(6):768–774

    CAS  Article  Google Scholar 

  22. Sobti N, Weitzman RE, Nealon KP, Jimenez RB, Gfrerer L, Mattos D, Ehrlichman RJ, Gadd M, Specht M, Austen WG, Liao EC (2020) Evaluation of capsular contracture following immediate prepectoral versus subpectoral direct-to-implant breast reconstruction. Sci Rep 10(1):1137

    CAS  Article  Google Scholar 

  23. Spear SL, Baker JL Jr (1995) Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 96(5):1119–1123 (discussion 1124)

    CAS  Article  Google Scholar 

  24. Kamel M, Protzner K, Fornasier V, Peters W, Smith D, Ibanez D (2001) The peri-implant breast capsule: an immunophenotypic study of capsules taken at explantation surgery. J Biomed Mater Res 58(1):88–96

    CAS  Article  Google Scholar 

  25. Marques M, Brown SA, Oliveira I, Cordeiro MNDS, Morales-Helguera A, Rodrigues A, Amarante J (2010) Long-term follow-up of breast capsule contracture rates in cosmetic and reconstructive cases. Plast Reconstr Surg 126(3):769–778

    CAS  Article  Google Scholar 

  26. Collis N, Coleman D, Foo IT, Sharpe DT (2000) Ten-year review of a prospective randomized controlled trial of textured versus smooth subglandular silicone gel breast implants. Plast Reconstr Surg 106(4):786–791

    CAS  Article  Google Scholar 

  27. Spear SL, Murphy DK, Allergan Silicone Breast Implant U.S. Core Clinical Study Group (2014) Natrelle round silicone breast implants: Core Study results at 10 years. Plast Reconstr Surg 133(6):1354–1361

    Article  Google Scholar 

  28. Gossner J (2016) Sonography in capsular contracture after breast augmentation: value of established criteria, new techniques and directions for research. J Ultrasound 20(1):87–89

    Article  Google Scholar 

  29. Ganott MA, Harris KM, Ilkhanipour ZS, Costa-Greco MA (1992) Augmentation mammoplasty: normal and abnormal findings with mammography and US. Radiographics 12(2):281–295

    CAS  Article  Google Scholar 

  30. Kim JH (2021) A rare case of a woman presenting with axillary silicone lymphadenopathy accompanied by extracapsular siliconoma and thickened capsule after an implant-based augmentation mammaplasty. J Surg Open Access 7(2):1–4. https://doi.org/10.16966/2470-0991.236

    Article  Google Scholar 

Download references

Funding

Non-applicable.

Author information

Authors and Affiliations

  1. The W Clinic, 9F Kukdong B/D, 596 Gangnam-daero, Gangnam-gu, Seoul, 06626, Korea

    Jae Hong Kim

  2. Department of Surgery, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea

    Sang Eun Nam

  3. BBC Plastic Surgery Clinic, Changwon, Korea

    Jung Youp Sung

  4. Department of Breast Surgery, Gwangju Suwan Hospital, Gwangju, Korea

    Keun Yeong Song

  5. Yang Hospital, Namyangju, Korea

    Bum Sik Bang

  6. Vievis NAMUH Hospital, Seoul, Korea

    Eun Kyoung Lee

Authors
  1. Jae Hong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sang Eun Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jung Youp Sung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Keun Yeong Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bum Sik Bang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eun Kyoung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jae Hong Kim.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

The current study was conducted in compliance with the relevant ethics guidelines; all procedures performed in it were in accordance with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed Consent

Written informed consent was waived due to the retrospective nature of the current study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kim, J.H., Nam, S.E., Sung, J.Y. et al. The Value of Capsule Thickness on Breast Ultrasound as an Indicator of the Severity of Capsular Contracture and Its Correlation with the Baker Classification. Aesth Plast Surg 46, 621–629 (2022). https://doi.org/10.1007/s00266-021-02544-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-021-02544-5

Keywords

  • Breast implants
  • Capsules
  • Implant capsular contracture
  • Ultrasonography
  • Morphological
  • Microscopic findings