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Histopathological Scoring Improves the Correlation Between Capsular Contracture Diagnosis and Patient-Reported

Maria O Snog, Tim K Weltz, Mads G Jørgensen

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    |November 18, 2025
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    Summary

    Histopathological confirmation improves the Baker classification

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    Area of Science:

    • Plastic Surgery
    • Surgical Pathology

    Background:

    • The Baker classification is a standard for grading capsular contracture post-breast implant surgery.
    • Current correlation between Baker grade and patient-reported outcomes (PROs) is suboptimal.

    Purpose of the Study:

    • To assess if histopathological verification of capsular contracture enhances the association between Baker grade and BREAST-Q scores.
    • Investigate the diagnostic utility of histology in capsular contracture assessment.

    Main Methods:

    • 103 women undergoing breast implant revision completed the BREAST-Q "Physical Well-Being-Chest" module.
    • Surgeons used the Baker scale; capsule biopsies were histopathologically scored.
    • Linear regression analyzed BREAST-Q scores against Baker grade in confirmed vs. misclassified cases.

    Main Results:

    • Histological confirmation of Baker grade was high in augmentation (91%) and reconstruction (80%) cases.
    • Confirmed Baker grade significantly correlated with worse chest well-being in augmentation patients (P=.003).
    • No significant correlation was found in misclassified augmentation cases or any reconstruction cases.

    Conclusions:

    • Histologically confirmed Baker classification significantly correlates with patient-reported chest well-being in breast augmentation.
    • Mismatch between Baker grade and histology diminishes this correlation.
    • Histopathological scoring may improve diagnostic accuracy for capsular contracture.