BACKGROUND: Silicone gel breast implants are associated with long-term adverse events, including capsular contracture, with reported incidence rates as high as 50 percent. However, it is not clear how long the follow-up period should be and whether there is any association with estrogen or menopausal status. In addition, the placement of Baker grade II subjects in the majority of reports has been in data sets of controls instead of capsular contracture. METHODS: A retrospective medical study (1998 to 2004) was performed in women (n = 157) who received textured silicone breast implants for aesthetic or reconstructive procedures at the Hospital of S. João (Portugal). Medical data were collected that included the following: patient demographics, history, lifestyle factors, surgical procedures, and postoperative complications. Statistical analyses included Pearson chi-square testing, logistic regression modeling, and chi-squared automatic interaction detection (CHAID) methods. RESULTS: The reconstructive cohort had a great incidence of capsular contracture compared with the cosmetic cohort. If one considered no capsular contracture versus capsular contracture, the follow-up period should be longer than 42 months. However, if considering no capsular contracture and grade II subjects versus grade III or IV subjects, a longer follow-up period of 64 months was determined. There was no association between capsular contracture and menopause/estrogen status. CONCLUSIONS: Increased frequencies of capsular contracture were recorded in breast reconstruction that were not attributable to estrogen or menopausal status. On the basis of these results, the authors propose a follow-up period longer than 42 months and the inclusion of Baker grade II subjects.