Capsular Contracture Correction in Korea

Baker Classification (Grade I-IV)

Capsular contracture severity is most commonly graded by the Baker classification, originally proposed by Dr. James Baker in 1975 and still in widespread clinical use. The classification combines clinical appearance and palpation findings:

What Causes Capsular Contracture?

A natural scar-tissue capsule forms around every breast implant as part of the body’s wound-healing response. In capsular contracture, this capsule thickens and contracts beyond the normal range. Contributing factors that have been described in the literature include:

• Post-operative hematoma or seroma — blood or fluid accumulation in the pocket may increase inflammation and fibrosis.
• Subclinical infection or bacterial biofilm — low-grade bacterial colonization on the implant surface is one of the most studied risk factors.
• Implant surface technology — surface texture, smoothness, and material may influence capsule biology.
• Radiation therapy — radiation to the breast (e.g., for cancer) is a well-recognized risk factor.
• Individual tissue response and prior contracture history — patients with prior contracture have higher recurrence risk.
• Surgical technique factors — bleeding control, pocket dissection accuracy, no-touch insertion (e.g., Keller Funnel), and pocket plane selection.

Sterile surgical technique, careful hemostasis, accurate pocket creation, and structured post-operative monitoring may help reduce risk, but capsular contracture cannot be entirely prevented.

How Is Capsular Contracture Diagnosed?

Diagnosis is primarily clinical — based on examination of breast firmness, shape distortion, displacement, and pain — and graded by the Baker classification. Adjunct imaging is selectively used:

• Ultrasound — bedside evaluation of implant integrity, fluid collections, and capsule thickness.
• MRI — FDA-recommended modality for evaluating silent silicone gel implant rupture, often performed at intervals after augmentation. Useful to rule out concurrent rupture in contracture cases.
• Mammography — not typically used to diagnose contracture itself but may be part of routine breast cancer screening for the patient.

At UNE Plastic Surgery, Dr. Kim Uigeon evaluates capsular condition together with soft-tissue thickness and previous operative records during in-person consultation, because revision technique depends on the combined picture.

Surgical Treatment Options

Surgical treatment for Baker Grade III-IV capsular contracture typically includes one or more of the following, individualized to the patient:

• Capsulectomy — surgical removal of the capsule. May be total / en bloc (capsule + implant removed together), subtotal, or partial. Generally preferred for higher Baker grades or when calcified capsule is present.
• Capsulotomy — release or partial opening of the capsule without removing it. May be appropriate for selected lower-grade cases or when preserving capsule integrity is needed (e.g., to retain implant pocket).
• Implant exchange — replacement of the existing implant with a new one, often combined with capsulectomy.
• Pocket conversion — changing the implant plane (e.g., subglandular to subpectoral or dual plane). May reduce visible irregularities and is sometimes used in revision when the original pocket is unsuitable.
• Adjunct measures — meticulous hemostasis, sterile no-touch implant insertion (Keller Funnel), and selection of implant surface technology based on the case.

The decision between these techniques depends on the Baker grade, implant status (brand, generation, integrity, age), tissue condition, and the patient’s goals. Revision is generally more complex than primary augmentation.

Recovery and Follow-up

Recovery after capsular contracture correction varies depending on the extent of surgery (capsulotomy vs. capsulectomy, implant exchange, pocket conversion), the use of drains, and individual healing. Many patients resume light daily activities within 1 to 2 weeks; return to upper-body exercise and travel should be decided after follow-up evaluation by the surgeon.

UNE Plastic Surgery provides structured post-operative follow-up including drain management when used, suture removal, scar care guidance, and routine imaging recommendations to monitor implant status. Recurrence of contracture cannot be entirely eliminated; long-term follow-up is recommended.