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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

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

  • Mihai Iliescu-Glaja1,2
  • Fabiana Simion2
  • Andrei Motoc3
  • Daciana Grujic2,4,5
  • Cristi Tarta6
  • Dana Stoian7
7 affiliations
  1. 1Doctoral School, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  2. 2Plastic and Reconstructive Surgery Department, Pius Brinzeu Clinical County Emergency Hospital Timisoara, Casa Austria, Liviu Rebreanu Blvd 156, 300723 Timisoara, Romania
  3. 3Department of Anatomy and Embryology, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  4. 4Plastic Surgery Department, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  5. 5Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
  6. 6Researching Future Surgery II Research Center, Department X, Discipline of General Surgery II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania
  7. 7Department of Internal Medicine II, Discipline of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{iliescuglaja2026shearwave,
  title = {{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}},
  author = {Mihai Iliescu-Glaja and Fabiana Simion and Andrei Motoc and Daciana Grujic and Cristi Tarta and Dana Stoian},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15218408},
  url = {https://www.mdpi.com/2077-0383/15/21/8408},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - 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
AU  - Mihai Iliescu-Glaja
AU  - Fabiana Simion
AU  - Andrei Motoc
AU  - Daciana Grujic
AU  - Cristi Tarta
AU  - Dana Stoian
PY  - 2026
DA  - 2026/10/28
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15218408
UR  - https://www.mdpi.com/2077-0383/15/21/8408
AB  - 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.
SN  - 2077-0383
ER  -