If there is one complication that is common it is very hard implant capsulation.  That is dreaded by all breast aug patients.  Their breasts become very hard – in some cases like “rocks”.  Everyone gets a capsule around their implants.  However these capsules contain collagen and cells that can contract like muscle cells – the result is hard breast implants.  One possible cause of severe encapsulation has to do with a thing calleda  BIOFILM.  A biofilm is a microbial community that attaches itself to the surface of something like a breast implant.  These biofilms can cause infection and they lead to increased inflammation and can prove difficult to treat.  Biofilms on breast implants can also lead to severe encapsulation.  Biofilms usually consist of multiple types of bacteria.  Several studies have been done linking biofilms to capsular contracture.  The choice of implant surface – smooth vs. textured is still controversial.  How to prevent it?  Pre-op antibiotics, intraoperative antibiotic irrigation, nipple shields, inframammary incision and washing with Hibiclens pre-operatively.