A Forgotten Entity following Breast Implant Contracture: Does Baker Need a Change?

Abstract

Introduction: Breast augmentation is one of the most common operative procedures in Plastic and Reconstructive surgery. However, it is associated with different postoperative complications. Local inflammation around the implant is followed by loss of cellular activity, shrinkage and necrosis. In very rare cases, the ultimate step of the process is capsular contracture and calcification (CC). Here we present the clinical case of a female patient with capsular calcification. In this patient we performed different examinations and the surgical removal of the implant. Although CC is traditionally staged with the Baker classification system, there is smarted heterogeneity between the objective contracture severity and patients’ subjective symptoms. Considering our clinical case and the need for a more comprehensive classification, we present an upgrade of the traditional Baker classification. Materials and Methods: We performed ultrasonography, RX-array and magnetic resonance imaging. In addition we performed a core needle biopsy and the surgical removal of breast implants. After a deep analysis of the history and the etiopathogenesis of capsular calcification and considering the heterogeneity of patients’ clinical signs and symptoms, we upgraded the traditional Baker classification system. Results: The addition of “(A)” (without symptoms) and “(B)” (with symptoms) should be added to all stages of the classification. Both for classification purposes and to potentially match patients’ objective data to clinical and histological parameters. The addition of a grade V within the classification will allow surgeons to report any neoformations present within the capsular microenvironment and better predict patients’ outcomes. Conclusion: By analyzing the current histological and clinical classification systems for CC by Wilflingseder and Baker, we additionally provide a “symptomatic” modification of the traditional Baker stages. The introduction of a symptomatic classification with the addition of grade within the Baker classification will allow surgeons to better report the clinical presentation of patients with CC.