One of the challenges of breast augmentation with a breast implant is the development of capsular contracture or hardening of the tissue around the implant with subsequent deformity of the breast. I have published a couple of landmark papers in the plastic surgery literature that have defined some of the risk factors for contracture and how to minimize it. When a breast implant is placed, the body forms a thin scar tissue capsule around it. In capsular contracture, the scar tissue contracts and shrinks around the breast implant causing unnatural hardness and deformity of the breast. The correction for this is a surgery to remove the surrounding scar tissue and exchange the implant, although this does not guarantee that the contracture will not return. In one of my studies, I identified the relationship between the incision location, either at the nipple or below the breast, and capsular contracture. This paper was the first in the plastic surgery literature to identify this relationship, and subsequent studies by other plastic surgeons have confirmed this. The incidence of contracture is lowest when the incision is located in the fold beneath the breast. The theory that I put forth for why this is the case is that with the nipple incision, more of the breast ducts are cut, and therefore the implant and developing capsule have more exposure to the bacteria colonizing the breast ducts. The main theory for the development of contracture is that the bacteria from the breast ducts adhere to the implant and cause the cells of the surrounding capsule to begin contracting, and this can develop months or years after surgery. The nipple incision is still a reasonable incision, however due to the lower incidence of capsular contracture, I strongly recommend the incision in the fold beneath the breast.