The cause of capsular contracture is generally unknown. In other words, in most cases, there is not a specific reason why the patient develops a capsular contracture. Nevertheless, three things have been determined to increase the chance of capsular contracture. If you develop a hematoma—in other words, bleeding after surgery with blood clots and blood around the implant—this can increase your chance of subsequently developing a capsular contracture, even when the complication has been resolved with further surgery. The reason behind this is that bleeding causes inflammation. Anything that makes your breast inflamed will increase the chances of developing a capsule that contract. For this particular reason, the surgeon’s technique is very important when it comes to breast augmentation. When I am performing a breast augmentation, my main goal is not only to create a very precise breast pocket to fit your needs, but also to minimize any bleeding during surgery. The less bleeding you have, the less your chance of developing a capsular contracture.The next factor is infection. Studies have shown that histologically some capsules have bacteria with subclinical infection; this means that the capsule has some small bacteria embedded in the tissue. This creates inflammation that results in a capsular contracture. For this reason, it is advised to give preoperative antibiotics prior to implant placement and also to irrigate the implant pocket with antibiotic solution. This has been shown to decrease the incidence of infection-related capsule contracture.The third factor is silicone implants. There is no question that silicone implants lead to a higher chance of capsule contracture. The reason is that the silicone particles can migrate through the silicone shell, and silicone by itself can promote inflammation. This is why every year companies like Mentor are coming out with newer and better implants with less of what is called silicone bleed. The more cohesive the implants are, like the new “gummy bears” that are currently on the market, the less the chance of capsular contracture; more cohesive silicone will stay within the boundaries of the implant itself and not bleed through the implant membrane to cause inflammation in the surrounding tissue that results in capsule contracture. Ask your surgeon about the different silicone implants he or she uses and the risks and benefits of each one. Preliminary reports show that the newer high-cohesive implants decrease the chances of developing a capsular contracture.