Background: Capsular contracture following augmentation mammoplasty is the most common complication requiring revision surgery. However there is a lack of single surgeon’s long term follow up regarding this most common complication. Methods: Retrospective data was retrieved using XL Spread Sheet, primary augmentation mammoplasty performed between May 1999 and August 2015 was reviewed. All patients had their surgery performed and followed up by a single surgeon. All patients had textured round cohesive gel silicone implants using inframammary incision with a minimum follow up of 1.5 years, were selected. Asymptomatic capsular contractures (Baker Grade I and II) were compared with symptomatic contractures (Grade III and IV) on the basis of the age of the patient, size of the implants and duration of implantation. Asymptomatic and symptomatic capsular contracture rate was also compared based on the position of the implants, smoking status of the patients and presence and absence of the drains. Results: There were 117 patients with a mean follow up of 6.6 years (range 1.5-12) in the series. Mean age of the patients was 32.2 years (range 18-53) with a mean implant size of 336.2 cc (range 230-540). Of 117 patients, 107 (91.5%) were asymptomatic with a mean age of 31.9 years , mean implant size of 336 cc with a mean implantation of 6.7 years as compared to symptomatic capsular contracture present in 10 patients (8.5%) with a mean age of 35.3 years, mean implant size of 339cc and with a mean duration of 6 years. Of the 49 patients who had mammoplasty in subglandular pocket, 3 (6.1%) presented with Grade III or IV capsular contracture. Submuscular augmentation was performed in 68 patients, of these 7 (10.3%) presented with symptomatic capsular contracture. Smoking status was known in 114 patients. Of these 114, 25 were smokers and Grade III and IV capsular contracture was present in 2 patients (8.0%) as compared to 89 non smokers of whom 8 (9.0%) presented with Grade III-IV capsular contracture. Drains were used in 15 patients, of these 2 patients (13.3%) developed capsular contracture. Of the 102 patients who had their surgery without drains, 8 patients (7.8%) developed Grade III-IV capsular contracture. Of the 117 patients, 11 patients who had implants failures, 3 (27.3 %) presented with Grade III-IV capsular contracture as compared 6 (11.8%) of the 51 patients who did not have implant damage. Conclusion: Incidence of capsular contracture in current long term series was 8.5%. There was no single cause identified for capsular contracture, including pocket of the implant placement, use of drains, smoking or implant rupture.