by de Bakker, Erik; Rots, Mathijs; Buncamper, Marlon E.;
Niessen, Frank B.; Smit, Jan Maerten; Winters, Henri A. H.; Özer, Müjde; de
Vet, Henrica C. W.; Mullender, Margriet G.
Plastic and
Reconstructive Surgery: November 2020
- Volume 146 - Issue 5 - p 956-962
Background:
Breast implants are frequently used in cosmetic and
reconstructive breast surgery. Capsular contracture, the most common long-term
complication, is usually graded using the Baker classification. Despite its
widespread use, the reliability of the Baker classification has never been
established. The aim of this study was to determine the interobserver
reliability and agreement of the Baker classification.
Methods:
Sixty women who had undergone cosmetic breast augmentation
were included. They were examined independently by two plastic surgeons from an
observer pool. The Baker score was determined, along with firmness,
dislocation, symmetry, and pain using four-point scales. Patients were asked to
complete the BREAST-Q postaugmentation module. The interobserver reliability
and agreement were calculated for all variables with a quadratic weighted
kappa.
Results:
The interobserver reliability of the Baker classification
was poor (kappa, 0.55; 95 percent CI, 0.37 to 0.72). Interobserver reliability
of the clinical parameters firmness (0.64; 95 percent CI, 0.49 to 0.79),
dislocation (0.49; 95 percent CI, 0.26 to 0.73), and symmetry (0.61; 95 percent
CI, 0.34 to 0.88) was also poor. Pain scores seemed more reliable (0.72; 95
percent CI, 0.56 to 0.89); however, most patients had no pain. The
interobserver agreement for the Baker score was 48 percent; in 43 percent, the
observers differed one category; and in 12 percent, the difference was more
than one category.
Conclusions:
Interobserver reliability and observer agreement of the
Baker classification for capsular contracture were poor. Consensus about how to
adequately rate the symptoms of capsular complaints is lacking. A more reliable
method of measurement or description is needed, especially for scientific
research purposes, to assess the long-term problems associated with breast
implants. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.
