Shear-Wave Elastography for Predicting the Occurrence and Assessing the Severity of Capsular Contracture After Implant-Based Breast Augmentation and Reconstruction: A Review of the Evidence

Capsular contracture (CC) is the most common long-term complication of implant-based breast augmentation and reconstruction, yet it is still graded by palpation with the Baker classification, whose interobserver reliability is poor. Shear-wave elastography (SWE) quantifies tissue stiffness non-invasively and could assess the periprosthetic capsule objectively. We searched bibliographic and publisher databases up to September 2026 and critically appraised every primary clinical report applying ultrasound elastography to the periprosthetic capsule. Eight reports (2011–2026; 2–51 patients each) from four groups were identified; seven used shear-wave techniques and one compression elastography. Wherever high-grade contracture was represented, periprosthetic stiffness increased with the Baker grade. After reconstruction, SWE was more reproducible than strain elastography and correlated more closely with the Baker score (r = 0.81 versus 0.70). In one comparative study, stiffness almost completely separated Baker III/IV reconstruction breasts from Baker I/II augmentation breasts (area under the curve 0.994), but the groups also differed in indication, age and protocol, so diagnostic accuracy cannot be inferred; neither proposed threshold (~52 and 82 kPa) has been externally validated. Longitudinal studies show early postoperative stiffening that partly normalizes within a year, but none has shown that early SWE predicts subsequent contracture. SWE is a promising adjunct to clinical assessment, not a stand-alone criterion for surgery; standardized acquisition, indication-matched validation and prospective predictive studies are required before clinical adoption.