Assessment of Capsular Contracture Based on Morphological Change of Breast Implant Using Computed Tomography

Abstract

Background

Capsular contracture is a common complication following implant-based breast reconstruction. Current assessment methods, primarily relying on the subjective Baker grading system, lack objectivity and quantitative data, which hinders large-scale studies and the development of treatment guidelines. To solve these problems, we conducted a study using computed tomography (CT) scans to quantitatively evaluate morphological changes in breast implants associated with capsular contracture.

Methods

We enrolled 94 patients who underwent breast reconstruction using implants and underwent periodic chest CT scans. We categorized them into two groups: Baker grade I or II (n = 72) and Baker grade III or IV (n = 22). We analyzed the CT scans to assess changes in the implant base and projection.

Results

In the Baker grade III or IV groups, it was confirmed that the ratio of projection to base increased after capsular contracture compared with before contracture. On the other hand, there was no significant change in the ratio of projection to base in the Baker grade I or II groups.

Conclusion

This study highlights the potential of CT scans as a reproducible method for evaluating capsular contracture. The ratio of projection to base could serve as a new quantitative index alongside the Baker grades for clinical assessment, treatment planning, and research on capsular contracture. When comparing the ratio of projection to base before and after capsular contracture, if the ratio of projection to base increases by more than 1.233 times, it can be considered Baker grade III or IV.

Keywords

breast implant - capsular contracture - Computed tomography

Note

This article was presented at the 13th Research and Reconstruction Forum on May 12, 2023, in Korea.

Ethical Approval

The study was approved by the Pusan National University Yangsan Hospital (IRB No. 55-2023-043) and performed in accordance with the principles of the Declaration of Helsinki.

Patient Consent

The patients provided written informed consent for the publication and use of their images.

Authors' Contributions

Conceptualization: S.B.N., W.S.O.

Data curation: S.H.L., J.Y.S.

Formal analysis: S.H.L., C.R.K.

Methodology: W.S.O., J.W.L.

Project administration: W.S.O., J.W.L.

Visualization: S.H.L., J.Y.S.

Writing—original draft: W.S.O., S.H.L.

Writing—review and editing: W.S.O., S.B.N.

Supervision: W.S.O., S.B.N.

All authors read and approved the final manuscript.

Publikationsverlauf

Eingereicht: 03. Oktober 2023

Angenommen: 23. März 2025

Artikel online veröffentlicht:
23. Juli 2025

• References

• 1 Wong CH, Samuel M, Tan BK, Song C. Capsular contracture in subglandular breast augmentation with textured versus smooth breast implants: a systematic review. Plast Reconstr Surg 2006; 118 (05) 1224-1236
• 2 Marques M, Brown SA, Oliveira I. et al. Long-term follow-up of breast capsule contracture rates in cosmetic and reconstructive cases. Plast Reconstr Surg 2010; 126 (03) 769-778
• 3 Henriksen TF, Fryzek JP, Hölmich LR. et al. Surgical intervention and capsular contracture after breast augmentation: a prospective study of risk factors. Ann Plast Surg 2005; 54 (04) 343-351
• 4 Gabriel SE, Woods JE, O'Fallon WM, Beard CM, Kurland LT, Melton III LJ. Complications leading to surgery after breast implantation. N Engl J Med 1997; 336 (10) 677-682
• 5 Taylor CW, Horgan K, Dodwell D. Oncological aspects of breast reconstruction. Breast 2005; 14 (02) 118-130
• 6 Cordeiro PG, McCarthy CM. A single surgeon's 12-year experience with tissue expander/implant breast reconstruction: Part II. An analysis of long-term complications, aesthetic outcomes, and patient satisfaction. Plast Reconstr Surg 2006; 118 (04) 832-839
• 7 Spear SL, Baker Jr JL. Classification of capsular contracture after prosthetic breast reconstruction. Plast Reconstr Surg 1995; 96 (05) 1119-1123 , discussion 1124
• 8 Mara JE, Baker Jr JJ. Diagnosis and treatment of masses in the augmented breast. Rocky Mt Med J 1978; 75 (05) 255-257
• 9 Zahavi A, Sklair ML, Ad-El DD. Capsular contracture of the breast: working towards a better classification using clinical and radiologic assessment. Ann Plast Surg 2006; 57 (03) 248-251
• 10 Tyagi N, Sutton E, Hunt M. et al. Morphologic features of magnetic resonance imaging as a surrogate of capsular contracture in breast cancer patients with implant-based reconstructions. Int J Radiat Oncol Biol Phys 2017; 97 (02) 411-419
• 11 Paetau AA, McLaughlin SA, McNeil RB. et al. Capsular contracture and possible implant rupture: Is magnetic resonance imaging useful?. Plast Reconstr Surg 2010; 125 (03) 830-835
• 12 Ganott MA, Harris KM, Ilkhanipour ZS, Costa-Greco MA. Augmentation mammoplasty: Normal and abnormal findings with mammography and US. Radiographics 1992; 12 (02) 281-295
• 13 Goodman CM, Cohen V, Thornby J, Netscher D. The life span of silicone gel breast implants and a comparison of mammography, ultrasonography, and magnetic resonance imaging in detecting implant rupture: A meta-analysis. Ann Plast Surg 1998; 41 (06) 577-585 , discussion 585–586
• 14 Berg WA, Nguyen TK, Middleton MS, Soo MS, Pennello G, Brown SL. MR imaging of extracapsular silicone from breast implants: Diagnostic pitfalls. AJR Am J Roentgenol 2002; 178 (02) 465-472
• 15 Cher DJ, Conwell JA, Mandel JS. MRI for detecting silicone breast implant rupture: Meta-analysis and implications. Ann Plast Surg 2001; 47 (04) 367-380
• 16 R Core Team. R: A language and environment for statistical computing. 2023 . R Foundation for Statistical Computing, Vienna, Austria. Accessed May 27, 20225 at: https://www.R-project.org/
• 17 Hinz B, Mastrangelo D, Iselin CE, Chaponnier C, Gabbiani G. Mechanical tension controls granulation tissue contractile activity and myofibroblast differentiation. Am J Pathol 2001; 159 (03) 1009-1020
• 18 Embrey M, Adams EE, Cunningham B, Peters W, Young VL, Carlo GL. A review of the literature on the etiology of capsular contracture and a pilot study to determine the outcome of capsular contracture interventions. Aesthetic Plast Surg 1999; 23 (03) 197-206
• 19 Chung KC, Malay S, Shauver MJ, Kim HM. Economic analysis of screening strategies for rupture of silicone gel breast implants. Plast Reconstr Surg 2012; 130 (01) 225-237
• 20 Wong T, Lo LW, Fung PYE. et al. Magnetic resonance imaging of breast augmentation: a pictorial review. Insights Imaging 2016; 7 (03) 399-410
• 21 Rotatori DS, Hathaway CL, Steinbach BG, Caffee HH. Noninvasive assessment of implant capsules. Plast Reconstr Surg 1991; 87 (04) 703-708
• 22 Gossner J. Breast implants on computed tomography-a pictorial review of normal and pathologic findings. Indian J Radiol Imaging 2021; 31 (04) 979-982