The exact cause of capsular contracture, or firmness and rounding up of the breast implant after augmentation is not clearly understood. The incidence can be affected by the type of implant used, and the location of the pocket. We know the saline implant has a lower capsule contracture rate than the silicone gel implant, and that submuscular placement has a much lower capsular contracture rate than a subglandular implant. Over long periods of time such as several years, again the saline implant stays softer while the rate of capsular contracture for the silicone gel implant continues to rise. When contracture does occur it is often seen within two to three months, often on one side only. We generally see contracture develop within the first two years and if not patients will not develop the problem except after many years in the case of the silicone gel implant. The contracture rates for the saline implant is about 2%, and for the silicone gel implant 10%. The number will vary depending on the particular sudy, or perhaps on a particular surgeon's experience. Once a patient develops a contracture massage may be beneficial, though open capsulotomy or cutting the capsule may be needed. The recurrence rate after cutting the capsule is 50%. Yes one out of two! Other options to consider may be replacement of a gel implant with a saline one, or placing a subglandular implant into a submuscular position. There are no effective medication to treat contracture at this time which has been shown safe and effective. Massage, and be hopeful, and best of luck, peterejohnsonmd