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

Abstract Background The Baker classification is used to grade capsular contracture after breast-implant surgery; yet, its correlation with patient-reported outcomes is poor. Objectives To determine whether histopathological verification of capsular contracture status strengthens the association between Baker grade and BREAST-Q scores. Methods Women scheduled for implant exchange or removal completed the BREAST-Q “Physical Well-Being-Chest” module. Raw BREAST-Q sum scores were transformed to a 0-100 scale, where higher scores indicate increased comfort. The attending surgeon classified breasts using the Baker scale (I-IV). Capsule biopsies were scored with a validated histopathological scoring system. Baker grades were deemed “confirmed” when histology and Baker grade were aligned and otherwise deemed “misclassified”. Linear regressions compared the relationship between BREAST-Q scores and Baker grade in confirmed vs misclassified cases. Results A total of 103 patients (58 augmentation, 45 reconstruction) were included. The Baker classification was confirmed histologically in 53/58 augmentation patients (91%), and 36/45 reconstruction patients (80%). In confirmed augmentation cases, each one-grade increase in Baker significantly worsened chest well-being by −8.80 BREAST-Q points (95% CI [−14.42, −3.18]; P = .003). No correlation was found in the misclassified augmentation cases (−3.21 points; P = .57), confirmed reconstruction cases (−5.00 points; P = .19), or in the misclassified reconstruction cases (−5.72 points; P = .54). Conclusions Histologically confirmed Baker classification correlates significantly with chest well-being assessed with BREAST-Q for the patients with breast augmentation, whereas no such correlation was observed in cases where the histology and Baker classification showed a mismatch. This suggests that histopathological scoring can increase diagnostic accuracy when assessing capsular contracture status. Level of Evidence: 3 (Therapeutic)