Evaluation of Capsular Contracture Grades

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Evaluation of Capsular Contracture Grades

The periprosthetic capsule that forms around breast implants is the body’s natural reaction to the insertion of a foreign object. Similar biological responses can occur after surgical insertion of pacemakers or other medical-grade implants. The formation of a capsule itself is not problematic, but when an excessive amount of this scar tissue surrounds the implant (capsular contracture), it can put pressure on the implant. This in turn may cause discomfort and lead to a compromised appearance.

While capsular contracture occurs only in a minority of breast augmentation patients, it is among the more common factors contributing to the need for breast revision surgery.

Many patients wonder when and if surgery to repair capsular contracture is necessary. The Baker Scale is a tool surgeons utilize to evaluate the necessity for surgical repair of capsular contracture following breast enlargement.

The Baker Scale

The Baker Scale is used to determine the degree of capsular contracture as well as the necessity for surgery prior to taking action. There are four grades; in general, the lower two don’t require surgery while the higher grades may need surgical treatment.

• Grade I – Breast feels soft and normal; capsule remains flexible.
• Grade II – Breast appears normal, but feels somewhat firm to the touch.
• Grade III – Breast is firmer and visually presents as abnormal; possible upward tilting of implant.
• Grade IV – Significant hardening of the capsule; breast is painful and looks abnormal.

Treatment Options

Surgical treatments for this condition include capsulotomy (opening of the capsule with an
electrocautery device) and capsulectomy (removal of impacted capsule). While surgery is generally not
indicated for Grade I or Grade II capsular contracture, nonsurgical options such as self-massage and ultrasound as well as certain medications indicated to aid in releasing the stiff capsule may be effective.

Article by
Denver Plastic Surgeon