Capsule contracture is still a poorly understood process, as we're still not entirely sure why it happens. While the Baker scale is somewhat subjective and arbitrary, it does attempt to give us some objective means to "quantify" the degree of capsule contracture. I personally don't call Baker I and II capsules "contractures," because I don't think of those as necessarily pathological processes that need treatment. However, once a capsule becomes obviously firm and changes the shape of the breast, meaning it progresses to Baker III, I do consider that a true "contracture." This is something that may never happen in a lady with Baker I or II capsules, or it may be a progressive thing, and over time the capsules may become firmer, more deforming, and maybe painful. This is something that we would watch, and if we felt that we were dealing with a progressive process, I would intervene and begin a medication like Singulair, possibly Celebrex or another NSAID, and maybe even steroids for a brief course, in order to prevent further progression, but again, this is only if I felt that there was an active progression in the condition. As far as how frequently this progression happens, I think you'll find answers all over the map depending upon the type of implants surgeons use, the location of incisions, and the medications used after surgery, as all of these things and other factors, have been shown to influence capsule contracture. In my practice I see clinically significant - again, Baker III and IV capsule contracture - about 2-3% of the time each year, and most of those are Baker III. I rarely see Baker IV capsule contractures. Most of the Baker III's and Baker IV's that I see did not "linger" in a Baker I or II stage for any length of time; in other words, they just progressively worsened until they hit their Baker III or IV plateau. Thus, it would be unusual in my experience, although again, not impossible, for a lady who had a Baker I or II capsule over some time to suddenly and spontaneously progress to a higher grade without some reason, like intervening pregnancy, breastfeeding, or mastitis. I hope that answers your question.
