apsular contracture remains one of the most unpredictable and problematic complications that occurs after breast augmentation. [1][2][3] Despite extensive study, the exact cause for the development of capsular contracture remains unclear. The most widely accepted cause relates to the formation of a bacterial biofilm inside the pocket that leads to chronic inflammation in the capsule with scarring, resulting in a variably firm, distorted, and sometimes painful breast. [3][4][5][6] Other potential contributing factors include seroma formation, bleeding, foreign body deposition such as talc from surgical gloves, gel bleed from older generation silicone gel implants, and implant rupture. 3,7 In addition , there are several different surgical planning and technique strategies that have been described in an attempt to reduce the rate of capsular contracture, often with conflicting results. Examples include the use of submuscular, 8,9 dual-plane, 10-12 or subfascial pockets [13][14][15] ; various types of textured surfaces that are either preventative 16,17 or have no effect [18][19][20][21] ; various incision locations [22][23][24] ; various medication regimens and pocket irrigation strategies [25][26][27][28][29][30][31][32][33] ; the use of nipple shields 23,33,34 or specially designed implant insertion sleeves [35][36][37][38] ; and specific postoperative care regimens. 39 Given these multiple variables