Capsular contracture, the most common complication in breast implant surgery, is primarily driven by bacterial biofilm formation. Risk is influenced by surgical factors such as incision choice, implant placement, and sterility. Textured implants do not reduce contracture and may increase complications, including breast implant–associated anaplastic large cell lymphoma. Evidence-based strategies—most notably the 14 point plan, betadine-based antimicrobial irrigations, meticulous surgical technique, and structured postoperative care—have reduced contracture rates from up to 50% historically to under 1% in modern practice. Comprehensive management with capsulectomy, site change, and adjuncts further optimizes long-term outcomes and patient satisfaction.