Contraction of fibrous capsules is the most common complication of augmentation mammaplasty using silicone implants. This contraction occurs unpredictably with all kinds of implants, and despite various surgical maneuvers to prevent it. Current clinical practices are reviewed. Wound healing around silicone breast implants is similar to that elsewhere in the body. Acute inflammation is followed by collagen synthesis. Breast capsules contain contractile fibroblasts like those found in other contracting scars. Silicones implanted into tissue undergo some detectable changes that at present cannot be related to capsular contraction. The possible roles of physical and chemical characteristics of the silicone implants are discussed. Steroids are widely used to prevent contraction, but much debate exists over whether or not they actually work. Other possible drug treatments are discussed, based on current research.